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Farghaly AAA, Ali H, Lupo P, Foresti S, De Ambroggi G, Atta S, Abdel-Galeel A, Tohamy A, Cappato R. Early versus Late Radiofrequency Catheter Ablation in Atrial Fibrillation: Timing Matters. J Clin Med 2024; 13:4643. [PMID: 39200784 PMCID: PMC11354874 DOI: 10.3390/jcm13164643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/05/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Despite the progressive course of atrial fibrillation (AF), the optimal timing of radiofrequency catheter ablation (RFCA) during disease course is still unknown. We aimed to investigate the impact of early RFCA within a year after AF diagnosis on procedural outcomes. Methods: A single-center retrospective study was conducted on symptomatic AF patients (n = 130) referred for RFCA with a 16-month median follow-up. Patients were stratified based on the diagnosis-to-ablation time (DAT) into early (≤1 year) and late (>1 year) RFCA groups. Atrial arrhythmia recurrence after single RFCA was the primary outcome. Secondary outcomes included cardiovascular hospitalizations, AF progression, and antiarrhythmic drug (AAD) use. Results: Within a year of AF diagnosis, 33 patients (25.4%) underwent RFCA. In the early-RFCA group, 84.4% of patients did not have recurrent atrial arrhythmia, in contrast to 60.8% in the late-RFCA group (p = 0.039). Late RFCA (HR = 2.74, 95% CI = 1.062-7.052, p = 0.037) and AF recurrence during the blanking period (HR = 4.57, 95% CI = 2.38-8.57, p < 0.0001) were independent predictors of atrial arrhythmia recurrence on multivariate analysis. Compared to the late-RFCA group, the early-RFCA group had significantly lower rates of cardiovascular hospitalizations (18% vs. 42%, p = 0.023), AF progression (0.0% vs. 11.3%, p = 0.044), and AAD use (45.4% vs. 81.4%, p < 0.001). Conclusions: Early RFCA within a year of AF diagnosis is associated with less atrial arrhythmia recurrence, fewer cardiovascular hospitalizations, less AF progression, and less AAD use. DAT of more than one year and AF recurrence during the blanking period are independent predictors of atrial arrhythmia recurrence after single RFCA.
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Affiliation(s)
- Ahmad A. A. Farghaly
- Arrhythmia & Electrophysiology Center, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy; (A.A.A.F.); (P.L.); (S.F.); (G.D.A.); (R.C.)
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Faculty of Medicine, Assiut University, Assiut 71526, Egypt; (S.A.); (A.A.-G.); (A.T.)
| | - Hussam Ali
- Arrhythmia & Electrophysiology Center, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy; (A.A.A.F.); (P.L.); (S.F.); (G.D.A.); (R.C.)
| | - Pierpaolo Lupo
- Arrhythmia & Electrophysiology Center, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy; (A.A.A.F.); (P.L.); (S.F.); (G.D.A.); (R.C.)
| | - Sara Foresti
- Arrhythmia & Electrophysiology Center, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy; (A.A.A.F.); (P.L.); (S.F.); (G.D.A.); (R.C.)
| | - Guido De Ambroggi
- Arrhythmia & Electrophysiology Center, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy; (A.A.A.F.); (P.L.); (S.F.); (G.D.A.); (R.C.)
| | - Salah Atta
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Faculty of Medicine, Assiut University, Assiut 71526, Egypt; (S.A.); (A.A.-G.); (A.T.)
| | - Ahmed Abdel-Galeel
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Faculty of Medicine, Assiut University, Assiut 71526, Egypt; (S.A.); (A.A.-G.); (A.T.)
| | - Aly Tohamy
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Faculty of Medicine, Assiut University, Assiut 71526, Egypt; (S.A.); (A.A.-G.); (A.T.)
| | - Riccardo Cappato
- Arrhythmia & Electrophysiology Center, IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy; (A.A.A.F.); (P.L.); (S.F.); (G.D.A.); (R.C.)
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Gangadharan AA, Muhammad LN, Song J, Knight BP, Passman R. Sex disparity in referral for catheter ablation for atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01854-3. [PMID: 38954237 DOI: 10.1007/s10840-024-01854-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/19/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Catheter ablation for atrial fibrillation (AFCA) has been shown to reduce AF burden and improve quality of life. Earlier studies demonstrated that women are less likely to undergo AFCA despite having more AF symptoms. We investigated whether an association exists between referral patterns and this sex disparity. METHODS A retrospective cohort study was conducted of outpatients with newly diagnosed AF at a single tertiary referral center. Logistic regression models adjusted for socioeconomic and clinical factors were constructed to determine associations between sex and binary dependent variables including referrals to and visits with general cardiology and electrophysiology (EP) and AFCA utilization. RESULTS Of 6850 patients analyzed, 2693 were women, and 4157 were men. No significant differences were found in odds of referral to (aOR, 1.13 [0.92-1.40], P = 0.25) or visits with (aOR, 1.05 [0.86-1.29], P = 0.62) general cardiologists between women and men. Women were found to be less likely to visit with EP than men (aOR, 0.88 [0.79-0.99], P = 0.03). In analyses of referral patterns after release of the 2014 AHA/ACC/HRS guidelines, women were found to be referred to (aOR, 0.78 [0.63-0.95], P = 0.01) and visit with (aOR, 0.86 [0.75-0.99], P = 0.03) EP less frequently than men. Finally, no significant difference was found in likelihood to undergo AFCA between women and men (aOR, 1.05 [0.83-1.33], P = 0.67). CONCLUSIONS This study uncovered significant differences in rates of referral to and visits with EP between women and men. Encouraging equitable referral to specialists and access to AFCA is essential in ensuring appropriate care for all patients.
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Affiliation(s)
- Arati A Gangadharan
- Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 600, Chicago, IL, 60611, USA.
| | - Lutfiyya N Muhammad
- Department of Preventative Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jing Song
- Department of Preventative Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bradley P Knight
- Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 600, Chicago, IL, 60611, USA
| | - Rod Passman
- Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 600, Chicago, IL, 60611, USA
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Marzak H, Rivière H, Fitouchi S, Cardi T, Kanso M, Morel O, Jesel L. The influence of left atrial volume on left atrial voltage in persistent atrial fibrillation patients without low-voltage zone: outcomes of pulmonary vein isolation. Europace 2024; 26:euae190. [PMID: 39031019 PMCID: PMC11259848 DOI: 10.1093/europace/euae190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 06/27/2024] [Indexed: 07/22/2024] Open
Affiliation(s)
- Halim Marzak
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - Hélène Rivière
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - Simon Fitouchi
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - Thomas Cardi
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - Mohamad Kanso
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - Olivier Morel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67091 Strasbourg, France
- UR 3074 Translational CardioVascular Medicine, CRBS, University of Strasbourg, Strasbourg, France
| | - Laurence Jesel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'Hôpital, 67091 Strasbourg, France
- UR 3074 Translational CardioVascular Medicine, CRBS, University of Strasbourg, Strasbourg, France
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Krisai P, Kühne M. Atrial fibrillation rhythm management: a matter of timing. Eur Heart J Suppl 2024; 26:iv61-iv68. [PMID: 39099576 PMCID: PMC11292412 DOI: 10.1093/eurheartjsupp/suae077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
Rhythm control in patients with atrial fibrillation (AF) has evolved dramatically in the last decades. Several studies have informed us of the benefits of an early rhythm control strategy and primary rhythm control by catheter ablation (CA). Similarly, several studies have investigated the effects of CA in patients with longer AF duration and more comorbidities, especially heart failure. In the current review, we summarize the current evidence on rhythm control at different time points during the disease course of AF [Table 1 and Central illustration].
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Affiliation(s)
- Philipp Krisai
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
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Crowley R, Lim MW, Chieng D, Segan L, William J, Morton JB, Lee G, Sparks P, McLellan AJ, Sugumar H, Prabhu S, Ling LH, Voskoboinik A, Pathak RK, Sterns L, Ginks M, Sanders P, Kistler PM, Kalman JM. Diagnosis to Ablation in Persistent AF: Any Time Can Be a Good Time to Ablate. JACC Clin Electrophysiol 2024; 10:1689-1699. [PMID: 39084743 DOI: 10.1016/j.jacep.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Nonrandomized data suggest that longer diagnosis-to-ablation time (DAT) is associated with poorer outcomes; however, a recent randomized trial found no difference in recurrences when ablation was delayed by 12 months. OBJECTIVES This study sought to assess the impact of DAT on atrial fibrillation (AF) recurrence in patients undergoing catheter ablation for persistent AF. METHODS CAPLA (Effect of Catheter Ablation Using Pulmonary Vein Isolation With vs Without Posterior Left Atrial Wall Isolation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation: The CAPLA randomized clinical trial) was a multicenter trial that randomized patients with persistent AF to pulmonary vein isolation + posterior wall isolation or pulmonary vein isolation alone. Follow-up was 12 months. Outcomes were assessed after a 3-month blanking period. RESULTS Median DAT in the 334 patients was 28 months (Q1-Q3: 12-66 months). Patients were divided into quartile groups: Q1 was DAT 0 to 12 months (n = 84, median DAT 7 months), Q2 was DAT 13 to 28 months (n = 85, median DAT 20 months), Q3 was DAT 29 to 66 months (n = 84, median DAT 41 months), and Q4 was DAT ≥67 months (n = 81, median DAT 119 months). AF recurrence rate was 36.9% for Q1, 44.7% for Q2, 47.6% for Q3, and 56.8% for Q4 (P = 0.082). On multivariable analysis, DAT Q4 was the only factor significantly associated with risk of recurrence (HR: 1.607; 95% CI: 1.005-2.570; P = 0.048). Median AF burden was 0% (Q1-Q3: 0%-0.47%) in Q1 and 0.33% (Q1-Q3: 0%-4.6%) in Q4 (P = 0.002). Quality of life (assessed by the Atrial Fibrillation Effect on Quality-of-Life questionnaire) improved markedly in all quartiles (Q1: Δ28.8 ± 24, Q2: Δ24.4 ± 23.4, Q3: Δ21.7 ± 26.6, Q4: Δ24.6 ± 21.4; P = 0.331). CONCLUSIONS In a cohort of patients with persistent AF undergoing ablation in a prospective trial with standardized entry criteria and intensive electrocardiogram monitoring, those with shorter DAT had lower rates of AF recurrence. However, differences were modest, and all quartiles demonstrated very low AF burden and improvements in quality of life.
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Affiliation(s)
- Rose Crowley
- University of Melbourne, Melbourne, Victoria, Australia; Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - Michael W Lim
- University of Melbourne, Melbourne, Victoria, Australia; Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Chieng
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | - Louise Segan
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | - Jeremy William
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | | | - Geoffrey Lee
- University of Melbourne, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Paul Sparks
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alex J McLellan
- University of Melbourne, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Hariharan Sugumar
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | - Sandeep Prabhu
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | - Liang-Han Ling
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | - Aleksandr Voskoboinik
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | | | | | | | | | - Peter M Kistler
- University of Melbourne, Melbourne, Victoria, Australia; Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | - Jonathan M Kalman
- University of Melbourne, Melbourne, Victoria, Australia; Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia.
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6
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Winkle RA. Response to letter to the editor. J Cardiovasc Electrophysiol 2024; 35:1320-1321. [PMID: 38664869 DOI: 10.1111/jce.16289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 06/14/2024]
Affiliation(s)
- Roger A Winkle
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, E. Palo Alto, CA and Sequoia Hospital, Redwood City, California, USA
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7
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Yuan Y, Zhu Y, Wu D, Wang J, Lin S, Zhu Y, Xu Y, Wu F. The Relationship Between Cardiac CT-based Left Atrial Structure and Epicardial Adipose Tissue and Postablation Atrial Fibrillation Recurrence Within 2 Years. J Thorac Imaging 2024:00005382-990000000-00140. [PMID: 38800955 DOI: 10.1097/rti.0000000000000789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
PURPOSE The aim of this study was to explore the association of cardiac CT-based left atrium (LA) structural and functional parameters and left atrial epicardial adipose tissue (LA-EAT) parameters with postablation atrial fibrillation (AF) recurrence within 2 years. MATERIALS AND METHODS Contrast-enhanced cardiac CT images of 286 consecutive AF patients (median age: 65 y; 97 females) who underwent initial ablation between June 2018 and June 2020 were retrospectively analyzed. Structural and functional parameters of LA, including maximum and minimum volume and ejection fraction of LA and left atrial appendage (LAA), and LA-EAT volume, were measured. The body surface area indexed maximum and minimum volume of LA (LAVImax, LAVImin) and LAA (LAAVImax, LAAVImin), and LA-EAT volume index (LA-EATVI) were calculated. Independent predictors of AF recurrence were determined using Cox regression analysis. The clinical predictors were added to the imaging predictors to build a combined model (clinical+imaging). The predictive performance of the clinical, imaging, and combined models was assessed using the area under the receiver operating characteristics curve (AUC). RESULTS A total of 108 (37.8%) patients recurred AF within 2 years after ablation at a median follow-up of 24 months (IQR=11, 32). LA and LAA size and LA-EAT volume were significantly increased in patients with AF recurrence (P<0.05). After the multivariable regression analysis, LA-EATVI, LAAVImax, female sex, AF duration, and stroke history were independent predictors for AF recurrence. The combined model exhibited superior predictive performance compare to the clinical model (AUC=0.712 vs. 0.641, P=0.023) and the imaging model (AUC=0.712 vs. 0.663, P=0.018). CONCLUSION Cardiac CT-based LA-EATVI and LAAVImax are independent predictors for postablation AF recurrence within 2 years and may provide a complementary value for AF recurrence risk assessment.
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Affiliation(s)
- Yuan Yuan
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University
- Department of Radiology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, Jiangsu Province
| | - Yinsu Zhu
- Department of Radiology, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia
| | - Dandan Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University
| | - Jun Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University
| | | | - Yaxin Zhu
- United Imaging Healthcare Co. Ltd, Shanghai, China
| | - Yi Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University
| | - Feiyun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University
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Stauffer N, Knecht S, Badertscher P, Krisai P, Hennings E, Serban T, Voellmin G, Osswald S, Sticherling C, Kühne M. Repeat catheter ablation after very late recurrence of atrial fibrillation after pulmonary vein isolation. Europace 2024; 26:euae096. [PMID: 38607938 PMCID: PMC11068271 DOI: 10.1093/europace/euae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/09/2024] [Indexed: 04/14/2024] Open
Abstract
AIMS Atrial fibrillation (AF) recurs in about one-third of patients after catheter ablation (CA), mostly in the first year. Little is known about the electrophysiological findings and the effect of re-ablation in very late AF recurrences (VLR) after more than 1 year. The aim of this study was to determine the characteristics and outcomes of the first repeat CA after VLR of AF after index CA. METHODS AND RESULTS We analysed patients from a prospective Swiss registry that underwent a first repeat ablation procedure. Patients were stratified depending on the time to recurrence after index procedure: early recurrence (ER) for recurrences within the first year and late recurrence (LR) if the recurrence was later. The primary endpoint was freedom from AF in the first year after repeat ablation. Out of 1864 patients included in the registry, 426 patients undergoing a repeat ablation were included in the analysis (28% female, age 63 ± 9.8 years, 46% persistent AF). Two hundred and ninety-one patients (68%) were stratified in the ER group and 135 patients (32%) in the LR group. Pulmonary vein reconnections were a common finding in both groups, with 93% in the ER group compared to 86% in the LR group (P = 0.052). In the LR group, 40 of 135 patients (30%) had a recurrence of AF compared to 90 of 291 patients (31%) in the ER group (log-rank P = 0.72). CONCLUSION There was no association between the time to recurrence of AF after initial CA and the characteristics and outcomes of the repeat procedure.
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Affiliation(s)
- Niklas Stauffer
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Elisa Hennings
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Teodor Serban
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Gian Voellmin
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
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Winkle RA, Hardwin Mead R, Engel G, Salcedo J, Brodt C, Barberini P, Lebsack C, Kong MH, Kalantarian S, Patrawala RA. Early ablation of newly diagnosed paroxysmal atrial fibrillation (NEWPaAF) versus newly diagnosed persistent atrial fibrillation (NEWPeAF): Comparison of patient populations and ablation outcomes. J Cardiovasc Electrophysiol 2024; 35:984-993. [PMID: 38486082 DOI: 10.1111/jce.16248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 02/23/2024] [Accepted: 02/29/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Little is known about very early atrial fibrillation (AF) ablation after first AF detection. METHODS We evaluated patients with AF ablation <4 months from newly diagnosed paroxysmal AF (NEWPaAF) and newly diagnosed persistent AF (NEWPeAF). We compared the two patient populations and compared ablation outcomes to those undergoing later ablation. RESULTS Ablation was done <4 months from AF diagnosis in 353 patients (135 = paroxysmal, 218 = persistent). Early ablation outcome was best for NEWPaAF versus NEWPeAF for initial (p = 0.030) but not final (p = 0.102) ablation. Despite recent AF diagnosis in both groups, they were clinically quite different. NEWPaAF patients were younger (64.3 ± 13.0 vs. 67.3 ± 10.9, p = 0.0020), failed fewer drugs (0.39 vs. 0.60, p = 0.007), had smaller LA size (4.12 ± 0.58 vs. 4.48 ± 0.59 cm, p < 0.0001), lower BMI (28.8 ± 5.0 vs. 30.3 ± 6.0, p = 0.016), and less CAD (3.7% vs. 11.5%, p = 0.007), cardiomyopathies (2.2% vs. 22.9%, p = 0.0001), hypertension (46.7% vs. 67.4%, p < 0.0001), diabetes (8.1% vs. 17.4%, p = 0.011) and sleep apnea (20.0% vs. 30.3%, p = 0.031). For NEWPaAF, early ablation AF-free outcome was no better than later ablation (p = 0.314). For NEWPeAF, AF-free outcomes were better for early ablation than later ablation (p < 0.0001). Delaying ablation allowed more strokes/TIAs in both AF types (paroxysmal p = 0.014, persistent p < 0.0001). CONCLUSIONS Patients presenting for early ablation after newly diagnosed persistent AF have more pre-existing comorbidities and worse initial ablation outcomes than patients with NEWPaAF. For NEWPaAF, there was no advantage to early ablation, as long as the AF remained paroxysmal. For NEWPeAF, early ablation gave better outcomes than later ablation and they should undergo early ablation. For both AF types, waiting was associated with more neurologic events, suggesting all patients should consider earlier ablation.
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Affiliation(s)
- Roger A Winkle
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, Palo Alto, California, USA
- Sequoia Hospital, Redwood City, California, USA
| | - R Hardwin Mead
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, Palo Alto, California, USA
- Sequoia Hospital, Redwood City, California, USA
| | - Gregory Engel
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, Palo Alto, California, USA
- Sequoia Hospital, Redwood City, California, USA
| | - Jonathan Salcedo
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, Palo Alto, California, USA
- Sequoia Hospital, Redwood City, California, USA
| | - Chad Brodt
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, Palo Alto, California, USA
- Sequoia Hospital, Redwood City, California, USA
| | - Patricia Barberini
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, Palo Alto, California, USA
- Sequoia Hospital, Redwood City, California, USA
| | - Cynthia Lebsack
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, Palo Alto, California, USA
- Sequoia Hospital, Redwood City, California, USA
| | - Melissa H Kong
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, Palo Alto, California, USA
- Sequoia Hospital, Redwood City, California, USA
| | - Shadi Kalantarian
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, Palo Alto, California, USA
- Sequoia Hospital, Redwood City, California, USA
| | - Rob A Patrawala
- Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, Palo Alto, California, USA
- Sequoia Hospital, Redwood City, California, USA
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Tønnesen J, Ruwald MH, Pallisgaard J, Rasmussen PV, Johannessen A, Hansen J, Worck RH, Zörner CR, Riis‐Vestergaard L, Middelfart C, Sørensen SK, Sattler S, Gislason G, Hansen ML. Lower Recurrence Rates of Atrial Fibrillation and MACE Events After Early Compared to Late Ablation: A Danish Nationwide Register Study. J Am Heart Assoc 2024; 13:e032722. [PMID: 38533962 PMCID: PMC11179760 DOI: 10.1161/jaha.123.032722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/02/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Guidelines recommend prioritizing treatment with antiarrhythmic drugs before referral of patients with atrial fibrillation to ablation, delaying a potential subsequent ablation. However, delaying ablation may affect ablation outcomes. We sought to investigate the impact of duration from diagnosis to ablation on the risk of atrial fibrillation recurrence and adverse events. METHODS AND RESULTS Using Danish nationwide registries, all patients with first-time ablation for atrial fibrillation were identified and included from 2010 to 2018. Patients were divided into 4 groups by diagnosis-to-ablation time: <1.0 year (early ablation), 1.0 to 1.9 years, 2.0 to 2.9 years, and >2.9 years (late ablation). The primary end point was atrial fibrillation recurrence after the 90-day blanking period, defined by admission for atrial fibrillation, cardioversions, use of antiarrhythmic drugs, or repeat atrial fibrillation ablations. The secondary end point was a composite end point of heart failure, ischemic stroke, or death, and each event individually. The study cohort consisted of 7705 patients. The 5-year cumulative incidence of atrial fibrillation recurrence in the 4 groups was 42.9%, 54.8%, 55.9%, and 58.4%, respectively. Hazard ratios were 1.20 (95% CI, 1.07-1.35), 1.29 (95% CI, 1.13-1.47), and 1.40 (95% CI, 1.28-1.53), respectively, with the early ablation group as reference. The hazard ratio for the combined secondary end point was 1.22 (95% CI, 1.04-1.44) in the late ablation group compared with the early ablation group. CONCLUSIONS In patients undergoing ablation for atrial fibrillation, early ablation was associated with a significantly lower risk of atrial fibrillation recurrence. Furthermore, the associated risk of heart failure, ischemic stroke, or death was significantly lower in early-compared with late-ablation patients.
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Affiliation(s)
- Jacob Tønnesen
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Martin H. Ruwald
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Jannik Pallisgaard
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Peter Vibe Rasmussen
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
- Bispebjerg and Frederiksberg HospitalCopenhagenDenmark
| | - Arne Johannessen
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Jim Hansen
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Rene H. Worck
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Christopher R. Zörner
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Lise Riis‐Vestergaard
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Charlotte Middelfart
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Samuel K. Sørensen
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Stefan Sattler
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
| | - Gunnar Gislason
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenDenmark
- The Danish Heart FoundationCopenhagenDenmark
| | - Morten Lock Hansen
- Department of CardiologyHerlev‐Gentofte University Hospital, University of CopenhagenHellerupDenmark
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenDenmark
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11
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Nastasă A, Sahloul MH, Iorgulescu C, Bogdan Ș, Scărlătescu A, Paja S, Pupaza A, Mitran R, Gondos V, Vătășescu RG. The Association between Diagnosis-to-Ablation Time and the Recurrence of Atrial Fibrillation: A Retrospective Cohort Study. Diseases 2024; 12:38. [PMID: 38391785 PMCID: PMC10888228 DOI: 10.3390/diseases12020038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Catheter ablation (CA) for atrial fibrillation (AF) is superior to antiarrhythmic drugs in maintaining sinus rhythm. Novel evidence suggests that increasing the time between the first diagnosis of AF and ablation, or diagnosis-to-ablation time (DAT), is a predictor for AF recurrence post-ablation. PURPOSE Our primary objective was to investigate the relationship between DAT and AF recurrence after a first ablation. METHODS Patients with AF who underwent CA in our center were enrolled consecutively, and a retrospective analysis was performed. DAT was treated as a continuous variable and reported as a median for the group with recurrence and the group without recurrence. DAT was also considered as a categorical variable and patients were stratified into three categories: DAT < 1 year, DAT < 2 years, and DAT < 4 years. RESULTS The cohort included 107 patients, with a mean age of 54.3 ± 11.7 years. Mean DAT was significantly longer in those with AF recurrence: 4.9(3.06) years versus 3.99(3.5) (p = 0.04). The Kaplan-Meier curve revealed a higher likelihood of AF-free status over time for patients with DAT < 2 years compared to those with DAT > 2 years (p = 0.04). Cox multivariate analysis indicated that left atrial volume index (LAVI), obstructive sleep apnoea (OSA), and DAT > 2 years were independently associated with AF recurrence after a single AF ablation procedure (p = 0.007, p = 0.02, and p = 0.03, respectively). CONCLUSION A shorter duration between the first AF diagnosis and AF ablation is associated with an increased likelihood of procedural success after a single AF ablation procedure.
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Affiliation(s)
- Alexandrina Nastasă
- Cardiology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Mohamad Hussam Sahloul
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Eroii Sanitari Bvd. 8, 050474 Bucharest, Romania
| | | | - Ștefan Bogdan
- Cardiology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Eroii Sanitari Bvd. 8, 050474 Bucharest, Romania
| | | | - Steliana Paja
- Clinical Emergency Hospital, 014461 Bucharest, Romania
| | | | - Raluca Mitran
- Clinical Emergency Hospital, 014461 Bucharest, Romania
| | - Viviana Gondos
- Department of Medical Electronics and Informatics, Polytechnic University of Bucharest, 060042 Bucharest, Romania
| | - Radu Gabriel Vătășescu
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Eroii Sanitari Bvd. 8, 050474 Bucharest, Romania
- Clinical Emergency Hospital, 014461 Bucharest, Romania
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12
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De Greef Y, Bogaerts K, Sofianos D, Buysschaert I. Impact of Diagnosis-to-Ablation Time on AF Recurrence: Pronounced the First 3 Years, Irrelevant Thereafter. JACC Clin Electrophysiol 2023; 9:2263-2272. [PMID: 37656100 DOI: 10.1016/j.jacep.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Diagnosis-to-ablation time (DAT) strongly predicts recurrence of atrial fibrillation (AF) after ablation. Whether this association holds with any lower and/or upper limits is unknown. OBJECTIVES The goal of this study was to assess the impact of DAT on AF recurrence in search of lower and upper DAT thresholds. METHODS A total of 2,000 patients with AF from 2 cohorts of 1,000 patients each (69% male; age 62 ± 10 years) undergoing pulmonary vein isolation (PVI) between 2005-2014 and 2017-2019 were followed up for 3 years. RESULTS Clinical success was achieved in 61.7% of patients. Median DAT decreased over time from 36 months (Q1-Q3: 12-72 months) in the first cohort to 12 months (Q1-Q3: 5-48 months) in the second cohort (P < 0.001). A multivariable Cox proportional hazards fitted model of AF recurrence rate in relation to DAT (range: 0-288 months) showed a steep rise in AF recurrence, from 27% to 40% in the first 36 months (d%/dt = 0.36), with a first inflection point at 36 months, and a less steep rise to 45% until 90 months (d%/dt = 0.09), with flattening beyond 90 months (d%/dt = 0.026). Rise in AF recurrence rate in the first 36 months was higher in patients with persistent AF (from 40% to 54%; d%/dt = 0.39) than in patients with paroxysmal AF (19% to 29%; d%/dt = 0.28). CONCLUSIONS The association between DAT and AF recurrence has no lower limit ("the shorter the better"), whereas little gain is to be expected beyond 36 months ("the longer the more irrelevant"). Our data advocate for performing PVI as early as possible, certainly within 3 years of AF diagnosis, and even more so in persistent AF.
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Affiliation(s)
- Yves De Greef
- Department of Cardiology, ZNA Heart Centre, Antwerp, Belgium; Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.
| | - Kris Bogaerts
- KU Leuven, Department of Public Health and Primary Care, I-BioStat, Leuven, Belgium; UHasselt, I-BioStat, Hasselt, Belgium
| | - Dimitrios Sofianos
- Cardiology Department, European Interbalkan Medical Center, Thessaloniki, Greece
| | - Ian Buysschaert
- Department of Cardiology, Heart Centre AZ Sint Jan, Bruges, Belgium
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13
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Liu Z, Yang Z, Lu Y, Wang H, Zou C. Short-term and long-term effects of cryoballoon ablation versus antiarrhythmic drug therapy as first-line treatment for paroxysmal atrial fibrillation: A systematic review and meta-analysis. Clin Cardiol 2023; 46:1146-1153. [PMID: 37469293 PMCID: PMC10577536 DOI: 10.1002/clc.24092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/21/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023] Open
Abstract
Cryoballoon ablation (CBA) is an effective treatment for drug-refractory atrial fibrillation (AF) patients. Whether CBA as a first-line treatment is superior in the rhythm control of AF than antiarrhythmic drugs (AAD) remains unclear. CBA is superior to AAD as initial therapy for rhythm control of paroxysmal atrial fibrillation (PAF). A comprehensive database search was performed in PubMed, Embase, Cochrane, and Web of Science from inception to March 22, 2023. Treatment efficacy was pooled using risk ratio (RR) and standardized mean difference (SMD) with a 95% confidence interval (CI). This study was registered with Prospero (CRD42023401596). Five randomized-controlled trials involving 923 patients and an observational study were included in this study. The CBA group had a significantly lower overall recurrence rate than the AAD group (CBA vs. AAD: RR = 0.59, 95% CI = 0.49-0.71, p < .05, I2 = 0). The incidence of persistent AF could be better controlled in the CBA group than in the AAD (CBA vs. AAD: RR = 0.17, 95% CI = 0.06-0.49, p < .05, I2 = 0). CBA could improve the quality of life (QoL) of patients better than AAD (CBA vs. AAD: SMD = 0.40, 95% CI = 0.14-0.67, p < .05, I2 = 68.5%). CBA can reduce hospitalization rate significantly than AAD at 36-month follow-up (CBA vs. AAD: RR = 0.29, 95% CI = 0.15-0.58, p < .05, I2 = 0%). Compared to AAD, CBA as first-line therapy could reduce the recurrence rate of atrial arrhythmia and incidence of persistent AF and improve QoL in PAF patients with lower incidences of hospitalization.
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Affiliation(s)
- Zirui Liu
- Department of CardiologyFirst Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Zhengkai Yang
- Department of CardiologyFirst Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Yu Lu
- Department of CardiologyFirst Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Haocheng Wang
- Department of CardiologyFirst Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Cao Zou
- Department of CardiologyFirst Affiliated Hospital of Soochow UniversitySuzhouChina
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14
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Sang C, Hu X, Zhang D, Shao Y, Qiu B, Li C, Li F, Zhang C, Wang Z, Chen M. The predictive value of left atrium epicardial adipose tissue on recurrence after catheter ablation in patients with different types of atrial fibrillation. Int J Cardiol 2023; 379:33-39. [PMID: 36893857 DOI: 10.1016/j.ijcard.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND A growing body of evidence supports that the left atrium epicardial adipose tissue (LA-EAT) is related to the occurrence and recurrence of atrial fibrillation (AF). The relationship between LA-EAT and the recurrence after radiofrequency catheter ablation (RFCA) in patients with different types of AF is still unclear. This study aims to evaluate the predictive value of LA-EAT on the recurrence of AF after RFCA in patients with different types of AF. METHODS 301 AF patients who underwent RFCA for the first time were divided into the paroxysmal atrial fibrillation (PAF) group (n = 181) and the persistent atrial fibrillation (PersAF) group(n = 120), which were followed up at 3, 6, and 12 months. All patients underwent left atrial computed tomography angiography (CTA) examination before the operation, and LA-EAT was measured using software (Advantage Workstation4.6, GE, USA). RESULTS After a median follow-up of 10.7 months, 73/301 patients (24.25%) had a recurrence of AF, including 43 /120(35.83%) patients with PersAF and 30/181(16.57%) patients with PAF. In multivariable Cox regression analysis, LA-EAT volume (OR = 1.053;95%CI: 1.024-1.083, p < 0.001), attenuation (OR = 0.949;95%CI:0.911-0.988, p = 0.012) and left atrial diameter (LAD) (OR = 1.063;95%CI:1.002-1.127,p = 0.043) were independent risk factors for recurrence in patients with PersAF but not in patients with PAF. CONCLUSION LA-EAT volume and attenuation are independent risk factors for recurrence after RFCA in patients with PersAF.
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Affiliation(s)
- Chuanyi Sang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
| | - Xiaoqin Hu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
| | - Dongdong Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
| | - Yameng Shao
- Department of Cardiology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang 471000, China
| | - Bowen Qiu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
| | - Chengzong Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
| | - Fei Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
| | - Chaoqun Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China.
| | - Zhirong Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
| | - Minglong Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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15
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Intrinsic Cardiac Neuromodulation in the Management of Atrial Fibrillation- A Potential Missing Link? Life (Basel) 2023; 13:life13020383. [PMID: 36836740 PMCID: PMC9966489 DOI: 10.3390/life13020383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/14/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Atrial fibrillation (AF) is the most common supraventricular arrhythmia that is linked with higher cardiovascular morbidity and mortality. Recent evidence has demonstrated that catheter-based pulmonary vein isolation (PVI) is not only a viable alternative but may be superior to antiarrhythmic drug therapy for long-term freedom from symptomatic AF episodes, a reduction in the arrhythmia burden, and healthcare resource utilization with a similar risk of adverse events. The intrinsic cardiac autonomic nervous system (ANS) has a significant influence on the structural and electrical milieu, and imbalances in the ANS may contribute to the arrhythmogenesis of AF in some individuals. There is now increasing scientific and clinical interest in various aspects of neuromodulation of intrinsic cardiac ANS, including mapping techniques, ablation methods, and patient selection. In the present review, we aimed to summarize and critically appraise the currently available evidence for the neuromodulation of intrinsic cardiac ANS in AF.
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16
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Pung X, Ching CK. Catheter ablation as first-line treatment for paroxysmal atrial fibrillation. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023. [DOI: 10.47102/annals-acadmedsg.2022466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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17
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Santi ND, Wu KY, Redpath CJ, Nery PB, Huang W, Burwash IG, Bernick J, Wells GA, McArdle B, Chow BWJ, Birnie DH, Garrard L, deKemp RA, Beanlands RSB. Metabolic activity of the left and right atria are differentially altered in patients with atrial fibrillation and LV dysfunction. J Nucl Cardiol 2022; 29:2824-2836. [PMID: 34993894 DOI: 10.1007/s12350-021-02878-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 10/13/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Alterations in atrial metabolism may play a role in the perpetuation of atrial fibrillation (AF). This study sought to compare 18F-fluorodeoxyglucose (FDG) uptake on PET, in patients with LV dysfunction versus those without AF. METHODS Seventy-two patients who underwent myocardial viability assessment were evaluated. AF patients (36) had persistent or permanent AF based on history and ECG. Patients without AF (36) were matched to AF patients based on sex, diabetes, age, and LVEF. Maximum and mean FDG Standard Uptake Values (SUV) in the left atrial (LA) wall and right atrial (RA) wall were measured. Tissue-to-blood ratios (TBR) were calculated as atrial wall to blood-pool activity. Atrial volumes were measured by echocardiography. RESULTS Maximum and mean FDG SUV and TBRs were significantly increased in the RA (but not the LA) of patients with AF compared to those without (P < 0.01). When accounting for changes in atrial volume, the presence of AF remained a significant predictor of higher RAMAX, but not RAMEAN FDG uptake. CONCLUSION In patients with LV dysfunction from ischemic cardiomyopathy, LA and RA glucose metabolism are differentially altered in those with persistent atrial fibrillation. Further investigations should elucidate the temporal relationship between AF and glucose metabolic changes, as a potential target for therapy.
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Affiliation(s)
- Nicolas D Santi
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada.
- Department of Cardiology, University of Toronto Faculty of Medicine, Toronto, ON, Canada.
| | - Kai Yi Wu
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada
- Department of Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - C J Redpath
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada
| | - Pablo B Nery
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada
| | - Wayne Huang
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada
- Department of Medicine, Queensway Carleton Hospital, Ottawa, ON, Canada
| | - Ian G Burwash
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada
| | - Jordan Bernick
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada
| | - George A Wells
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada
| | - Brian McArdle
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada
- Royal Jubilee Hospital, Victoria, BC, Canada
| | - Benjamin W J Chow
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada
| | - David H Birnie
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada
| | - Linda Garrard
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada
| | - Robert A deKemp
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada
| | - Rob S B Beanlands
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada.
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Haq IU, Akhiyat N, Anan AR, Alzubi H, Kowlgi GN, Lee HC, Asirvatham SJ, Deshmukh AJ, DeSimone CV. Mediastinal radiation therapy for breast cancer in female patients is an independent risk factor for atrial fibrillation recurrence post-catheter ablation. J Interv Card Electrophysiol 2022; 65:751-756. [PMID: 35963910 DOI: 10.1007/s10840-022-01341-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/09/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of this study was to assess the safety, efficacy, and predictors of outcomes for atrial fibrillation (AF) ablation in patients with a history of breast cancer. METHODS Consecutive patients with a history of breast cancer undergoing AF ablation from January 2010 to December 2021 were propensity matched in a 1:1 ratio to patients without a history of any cancer. The primary outcome was procedural efficacy, defined by clinical AF recurrence and repeat catheter ablation. The secondary outcome was an assessment of safety looking at eight peri-procedural events. RESULTS Our cohort was comprised of 82 female patients, 41 patients with a history of breast cancer (mean age, 74.6 ± 7.4 years), and 41 patients with no history of cancer (76.7 ± 8.1 years). Both groups had similar echocardiographic, baseline, and arrhythmia characteristics. Breast cancer patients were at an increased risk of AF recurrence post-ablation compared to non-cancer patients (OR 2.68, 95% CI 1.05-6.86, p = 0.04). Multivariate analysis found prior mediastinal radiotherapy (OR 4.79, 95% CI 1.34-17.1) and AF diagnosis to ablation time (OR 1.2, 95% CI 1.03-1.29) were both independent predictors of AF recurrence post-ablation. CONCLUSION Our study suggests that female patients with a history of breast cancer are at a higher risk of developing AF recurrence after catheter ablation. Multivariate analysis showed that patients with a history of prior mediastinal radiation therapy and AF diagnosis to time to ablation were both independent risk factors.
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Affiliation(s)
- Ikram U Haq
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nadia Akhiyat
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Abu Rmilah Anan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hossam Alzubi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Hon-Chi Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Gomez SE, Fazal M, Nunes JC, Shah S, Perino AC, Narayan SM, Tamirisa KP, Han JK, Rodriguez F, Baykaner T. Racial, ethnic, and sex disparities in atrial fibrillation management: rate and rhythm control. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01383-x. [PMID: 36224481 PMCID: PMC10097842 DOI: 10.1007/s10840-022-01383-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) affects around 6 million Americans. AF management involves pharmacologic therapy and/or interventional procedures to control rate and rhythm, as well as anticoagulation for stroke prevention. Different populations may respond differently to distinct management strategies. This review will describe disparities in rate and rhythm control and their impact on outcomes among women and historically underrepresented racial and/or ethnic groups. METHODS This is a narrative review exploring the topic of sex and racial and/or ethnic disparities in rate and rhythm management of AF. We describe basic terminology, summarize AF epidemiology, discuss diversity in clinical research, and review landmark clinical trials. RESULTS Despite having higher rates of traditional AF risk factors, Black and Hispanic adults have lower risk of AF than non-Hispanic White (NHW) patients, although those with AF experience more severe symptoms and report lower quality-of-life scores than NHW patients with AF. NHW patients receive antiarrhythmic drugs, cardioversions, and invasive therapies more frequently than Black and Hispanic patients. Women have lower rates of AF than men, but experience more severe symptoms, heart failure, stroke, and death after AF diagnosis. Women and people from diverse racial and ethnic backgrounds are inadequately represented in AF trials; prevalence findings may be a result of underdetection. CONCLUSION Race, ethnicity, and gender are social determinants of health that may impact the prevalence, evolution, and management of AF. This impact reflects differences in biology as well as disparities in treatment and representation in clinical trials.
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Affiliation(s)
- Sofia E Gomez
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | - Muhammad Fazal
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | - Julio C Nunes
- Stanford Center for Clinical Research, Stanford University, Stanford, CA, USA.,Department of Psychiatry, Yale University, New Haven, CT, USA.,Cardiac Arrhythmia Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Shayena Shah
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | - Alexander C Perino
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | - Sanjiv M Narayan
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | | | - Janet K Han
- Cardiac Arrhythmia Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine, UCLA Cardiac Arrhythmia Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Fatima Rodriguez
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | - Tina Baykaner
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA.
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Robinson A, Chopra N, Badin AG, Billakanty SR, Cooper K, Fu EY, James J, Murnane V, Swinning J, Stelzer M, Tyler JD, Amin AK. Impact of a dedicated atrial fibrillation clinic on diagnosis-to-ablation time. Heart Rhythm O2 2022; 3:639-646. [PMID: 36589916 PMCID: PMC9795309 DOI: 10.1016/j.hroo.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Outcomes following catheter ablation (CA) for atrial fibrillation (AF) improve as the diagnosis-to-ablation time (DAT) shortens. Use of a protocol-based integrated care model through a dedicated atrial fibrillation clinic (AFC) may serve to standardize treatment pathways and decrease DAT. Objective To evaluate the DAT and clinical characteristics of patients with AF referred from an AFC vs a conventional electrophysiology clinic (EC). Methods Retrospective analysis was completed in consecutive patients undergoing index AF ablation at Riverside Methodist Hospital in 2019 with minimum 1 year follow-up. Patients were categorized based off their CA referral source (AFC vs EC) and where the initial visit following index diagnosis of AF occurred (AFC vs EC). Results A total of 182 patients (mean age 65 years, 64% male) were reviewed. Patients referred from an AFC (21%) had a median DAT of 342 days (interquartile range [IQR], 125-855 days) compared to patients referred from EC (79%) with a median DAT of 813 days (IQR, 241-1444 days; P = .01). Patients with their index visit following AF diagnosis occurring in the AFC (9%) had significantly shorter median DAT (127 days [IQR, 95-188 days]) compared to EC (91%) (789 days [IQR, 253-1503 days]; P = .002). Patients with DAT <1 year had lower AF recurrence than patients with DAT >1 year (P = .04, hazard ratio = 0.58, 95% confidence interval 0.3418-1.000). Conclusion DAT is a modifiable factor that may affect CA outcomes. Significant reductions in DAT were observed in patients evaluated through a dedicated AF clinic.
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Affiliation(s)
- Andrea Robinson
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio,Address reprint requests and correspondence: Ms Andrea Robinson, Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3535 Olentangy River Rd, Columbus, OH 43214.
| | - Nagesh Chopra
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Auroa G. Badin
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Sreedhar R. Billakanty
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Keaira Cooper
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Eugene Y. Fu
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Jennifer James
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Victoria Murnane
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Jill Swinning
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Mitchell Stelzer
- Department of Internal Medicine, OhioHealth Doctors Hospital, Columbus, Ohio
| | - Jaret D. Tyler
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Anish K. Amin
- Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
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Zhao Z, Zhang F, Ma R, Bo L, Zhang Z, Zhang C, Wang Z, Li C, Yang Y. Development and Validation of a Risk Nomogram Model for Predicting Recurrence in Patients with Atrial Fibrillation After Radiofrequency Catheter Ablation. Clin Interv Aging 2022; 17:1405-1421. [PMID: 36187572 PMCID: PMC9521706 DOI: 10.2147/cia.s376091] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/06/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose This study aimed to develop and validate a risk nomogram model for predicting the risk of atrial fibrillation recurrence after radiofrequency catheter ablation. Patients and Methods A retrospective observational study was conducted using data from 485 patients with atrial fibrillation who underwent the first radiofrequency ablation in our hospital from January 2018 to June 2021. All patients were randomized into training cohort (70%; n=340) and validation cohort (30%; n=145). Univariate and multivariate logistic regression analyses were used to identify independent risk factors. The predictive nomogram model was established by using R software. The nomogram was developed and evaluated based on differentiation, calibration, and clinical efficacy by concordance statistic (C-statistic), calibration plots, and decision curve analysis (DCA), respectively. Results The nomogram was established by four variables including left atrial diameter (OR 1.057, 95% CI 1.010–1.107, P=0.018), left ventricular ejection fraction (OR 0.943, 95% CI 0.905–0.982, P=0.005), type of atrial fibrillation (OR 2.164, 95% CI: 1.262–3.714), and systemic inflammation score (OR 1.905, 95% CI 1.408–2.577). The C-statistic of the nomogram was 0.741 (95% CI: 0.689–0.794) in the training cohort and 0.750 (95% CI: 0.670–0.831) in the validation cohort. The calibration plots showed good agreement between the predictions and observations in the training and validation cohorts. Decision curve analysis and clinical impact curves indicated the clinical utility of the predictive nomogram. Conclusion The nomogram model has good discrimination and accuracy, which can screen high-risk groups intuitively and individually, and has a certain predictive value for atrial fibrillation recurrence in patients after radiofrequency ablation.
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Affiliation(s)
- Zhihao Zhao
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Fengyun Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Ruicong Ma
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Lin Bo
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Zeqing Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Chaoqun Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Zhirong Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Chengzong Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Yu Yang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
- Correspondence: Yu Yang, Tel +86-15651359875, Email
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22
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Aguilera J, Hutt E, Kaur S, Saliba WI, Tarakji KG, Baranowski B, Bhargava M, Kanj M, Cantillon DJ, Rickard J, Sroubek J, Nakagawa H, Wazni OM, Hussein AA. Outcomes of atrial fibrillation ablation in patients with or without silent pulmonary veins from prior ablation procedure. J Cardiovasc Electrophysiol 2022; 33:1994-2000. [PMID: 35689504 DOI: 10.1111/jce.15592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/15/2022] [Accepted: 05/01/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Pulmonary venous (PV) electrical recovery underlies most arrhythmia recurrences after atrial fibrillation (AF) ablation. Little is known about procedural profiles and outcomes of patients with electrically silent PVs upon redo ablation for AF. METHODS In a prospectively maintained registry, we enrolled 838 consecutive patients (2013-2016) undergoing redo ablation procedures. Ablation procedures targeted the PVs, the PV antra, and non-PV sites at operators' discretion. Procedural profiles and clinical outcomes were assessed. The primary outcome was freedom from AF after a 3-month blanking period. The secondary outcome was improvement in quality of life. RESULTS Most patients undergoing redo AF ablation (n = 684, 82%) had PV reconnection while the remaining 154 (18%) had electrically silent PVs. Patients with recurrent AF and electrically silent PVs were older (66 vs. 64 years, p = .02), had more prior ablation procedures (median 2 IQR 1-3 vs 1 IQR 1-2 p = .001), were more likely to have non-paroxysmal AF (62% vs. 49%, p = .004) and atrial flutter (48% vs. 29%, p = .001) and had significantly larger left atrial volumes (89 vs. 81 ml, p = .003). Patients with silent PVs underwent a more extensive non-PV ablation strategies with antral extension of prior ablation sets in addition to ablation of the roof, appendage, inferior to the right PVs, peri-mitral flutter lines, cavotricuspid isthmus lines and ablation in the coronary sinus. Upon one year of follow-up, patients with electrically silent PVs were less likely to remain free from recurrent atrial arrhythmias (64% vs. 76%, p = .008). Regardless of PV reconnection status, redo ablation resulted in improvement in quality of life. CONCLUSION Rhythm control with extensive ablation allowed maintenance of sinus rhythm in about two thirds of patients with silent PVs during redo AF ablation procedures. Regardless of PV reconnection status, redo ablation resulted in improvement in quality of life. This remains a challenging group of patients, highlighting the need to better understand non-PV mediated AF.
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Affiliation(s)
- Jose Aguilera
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Erika Hutt
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Simrat Kaur
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Khaldoun G Tarakji
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel J Cantillon
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Rickard
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hiroshi Nakagawa
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
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23
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Prasitlumkum N, Tokavanich N, Trongtorsak A, Cheungpasitporn W, Kewcharoen J, Chokesuwattanaskul R, Akoum N, Jared Bunch T, Navaravong L. Catheter Ablation for Atrial Fibrillation in the Elderly > 75 Years old: Systematic Review and Meta-Analysis. J Cardiovasc Electrophysiol 2022; 33:1435-1449. [PMID: 35589557 DOI: 10.1111/jce.15549] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/30/2022] [Accepted: 05/11/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) ablation is increasingly performed worldwide. As comfort with AF ablation increases, the procedure is increasingly used in patients that are older and in those with more comorbidities. However, it is not well established whether AF ablation in the elderly, especially those >75 years old, has comparable safety and efficacy to younger populations. OBJECTIVE To compare the efficacy and safety profiles in patients older than 75years undergoing AF ablation with younger patients. METHODS Databases from EMBASE, Medline, PubMed and Cochrane, were searched from inception through September 2021. Studies that compared the success rates in AF catheter ablation and all complications rates between patients who were older vs under 75 years were included. Effect estimates from the individual studies were extracted and combined using random effect, generic inverse variance method of DerSimonian and Laird. RESULTS Twenty-seven observational studies were included in the analysis consisting of 363,542 patients who underwent AF ablation. Comparing patients older than 75 years old to younger patients, there was no difference in the success of ablation rates between elderly and younger patients (pooled OR 0.85: 95% CI:0.69 - 1.05, p=0.131). On the other hand, AF ablation in the elderly was associated with higher complication rates (pooled OR 1.43: 95% CI:1.21 - 1.68, p<0.001) CONCLUSION: As AF ablation is expanded to elderly populations, our study found that AF ablation success rates were similar in both elderly and younger patients. However, older patients experience higher rates of complications that should be considered when offering the procedure and as a means to improve outcomes with future innovations. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Narut Prasitlumkum
- Division of Cardiology, University of California Riverside, Riverside, CA, USA
| | - Nithi Tokavanich
- Department of Cardiovascular Medicine, Vajira Hospital, Bangkok, Thailand
| | - Angkawipa Trongtorsak
- Department of Internal Medicine, AMITA Health Saint Francis Hospital, Evanston, IL, USA
| | | | - Jakrin Kewcharoen
- Department of Cardiovascular Medicine, Loma Linda University, Loma Linda, CA
| | - Ronpichai Chokesuwattanaskul
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Nazem Akoum
- Department of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - T Jared Bunch
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Leenhapong Navaravong
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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24
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Andrade JG, Turgeon RD, Macle L, Deyell MW. Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation. Eur Cardiol 2022; 17:e10. [PMID: 35432602 PMCID: PMC9006125 DOI: 10.15420/ecr.2021.38] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022] Open
Abstract
AF is a common chronic and progressive disorder. Without treatment, AF will recur in up to 75% of patients within a year of their index diagnosis. Antiarrhythmic drugs (AADs) have been proven to be more effective than placebo at maintaining sinus rhythm and remain the recommended initial therapeutic option for AF. However, the emergence of ‘single-shot’ AF ablation toolsets, which have enabled enhanced procedural standardisation and consistent outcomes with low rates of complications, has led to renewed interest in determining whether first-line catheter ablation may improve outcomes. The recently published EARLY-AF trial evaluated the role of initial cryoballoon ablation versus guideline-directed AAD therapy. Compared to AADs, an initial treatment cryoballoon ablation strategy resulted in greater freedom from atrial tachyarrhythmia, superior reduction in AF burden, greater improvement in quality of life and lower healthcare resource utilisation. These findings are relevant to patients, providers and healthcare systems when considering the initial treatment choice for rhythm-control therapy.
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Affiliation(s)
- Jason G Andrade
- University of British Columbia, Canada; Center for Cardiovascular Innovation, Vancouver, Canada; Montreal Heart Institute, Université de Montréal, Canada
| | | | - Laurent Macle
- Montreal Heart Institute, Université de Montréal, Canada
| | - Marc W Deyell
- University of British Columbia, Canada; Center for Cardiovascular Innovation, Vancouver, Canada
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25
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Patterns of Care for First-detected Atrial Fibrillation: Insights from the Get With The Guidelines Atrial Fibrillation Registry. Heart Rhythm 2022; 19:1049-1057. [PMID: 35247626 DOI: 10.1016/j.hrthm.2022.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite multiple trials comparing rate with rhythm control, there is no consensus on optimal management of first-detected atrial fibrillation (AF). OBJECTIVE We analyzed current patterns of care for first-detected AF in the nationwide Get With The Guidelines®- Atrial Fibrillation Registry METHODS: Patients hospitalized with first-detected AF from 2013-19 were included and a descriptive analysis was performed comparing planned rate vs rhythm control. Multivariable logistic regression analysis was performed to identify predictors for choosing rhythm over rate control. RESULTS Among 86,759 patients with AF, 17.8% (15,473) had first-detected AF, 11,685 patients were included from 126 sites. Overall, 51.3% of patients were treated with rate control, and 48.7% with rhythm control at admission. Patients with planned rhythm control had a shorter length of stay and were more likely to be discharged home than a facility. A higher percentage of patients with planned rhythm control were discharged on anticoagulation compared to planned rate control (75.6% vs 70.9%) despite a higher underlying stroke risk in the rate control group (higher median CHA2DS2VASc-score (4; Q1-Q3 2-5 vs 3; Q1-Q32-4; p<0.001). While Hispanic ethnicity, Medicaid insurance, age >70 years, and liver disease decreased the likelihood of rhythm control, factors like heart failure, stroke, or prior bleeding diathesis had no association with the chosen treatment strategy. CONCLUSIONS Less than half of the patients with first-detected AF receive rhythm control at admission. Given recent trial results, further studies should assess the long-term impact of rhythm control on patients' symptoms and quality of life, cardiovascular morbidity, and mortality.
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26
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D'Angelo RN, Khanna R, Wong C, Yeh RW, Goldstein L, Marcello S, Tung P, D'Avila A, Zimetbaum PJ. Very early versus early referral for ablation among young patients for newly diagnosed paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2022; 45:348-356. [PMID: 35150152 DOI: 10.1111/pace.14459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/10/2022] [Accepted: 01/30/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Catheter ablation (CA) has emerged as an effective therapy for the treatment of paroxysmal atrial fibrillation, however it is unclear whether proceeding expeditiously to CA improves clinical outcomes in a real-world population. This study compares outcomes of catheter ablation for new atrial fibrillation (AF) within 6 months of diagnosis (very early) 6 to 12 months after diagnosis (early) and 12 to 24 months after diagnosis (later). METHODS A large nationally-representative sample of patients ages 18 to 64 who underwent CA from January 2011 to June 2019 was studied using the IBM MarketScan® Database. The primary outcome was a composite of healthcare utilization over the following 24 months. Propensity score-matching was used to match patients in each cohort. Risk difference in outcomes were compared between matched patients. RESULTS 2,631 patients were identified post-matching, with 1,649 in the very early cohort and 982 in the early cohort. The very early referral group was less likely to experience the primary composite outcome post-ablation (Absolute risk difference [ARD]: -3.9%; 95% Confidence interval [CI]: -5.8%, -2.0%), with the difference driven by fewer cardioversions (ARD: -2.9%, 95% CI: -5.3%, -0.5%) and outpatient visits (ARD: -6.6%, 95% CI: -10.5%, -2.7%). There was no difference in outcomes between early and later referral groups, with only very early referral showing decreased healthcare utilization. CONCLUSIONS Patients who underwent ablation within 6 months of diagnosis had lower healthcare utilization in the ensuing 24 months, driven by fewer outpatient visits and cardioversions, supporting expeditious referral for ablation for symptomatic AF. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Robert N D'Angelo
- Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Rahul Khanna
- Medical Device Epidemiology and Real World Data Science, Johnson and Johnson
| | - Charlene Wong
- Medical Device Epidemiology and Real World Data Science, Johnson and Johnson
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Laura Goldstein
- Franchise Health Economics and Market Access, Johnson and Johnson
| | | | - Patricia Tung
- Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Andre D'Avila
- Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Peter J Zimetbaum
- Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School
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Chew DS, Jones KA, Loring Z, Black-Maier E, Noseworthy PA, Exner DV, Packer DL, Grant J, Mark DB, Piccini JP. Diagnosis-to-ablation time predicts recurrent atrial fibrillation and rehospitalization following catheter ablation. Heart Rhythm O2 2021; 3:23-31. [PMID: 35243432 PMCID: PMC8859793 DOI: 10.1016/j.hroo.2021.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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28
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Solimene F, Giannotti Santoro M, Stabile G, Malacrida M, De Simone A, Pandozi C, Pelargonio G, Rossi P, Battaglia A, Pecora D, Bongiorni MG, Zucchelli G, Stocco C, Arestia A, Iuliano S, Russo M, Narducci ML, Segreti L. Early rhythm-control ablation therapy to prevent atrial fibrillation recurrences: Insights from the CHARISMA Registry. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:2031-2040. [PMID: 34606098 DOI: 10.1111/pace.14374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/03/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND An early, comprehensive rhythm-control therapy is needed in order to treat atrial fibrillation (AF) effectively and to improve ablation outcomes. METHODS A total of 153 consecutive patients from the CHARISMA registry undergoing AF ablation at eight centers were included. Patients with de novo PVI were classified as having undergone early treatment (ET) if the procedure was performed within 6 months after the first AF episode, and as having undergone delayed treatment (DT) if ablation was performed over 6 months after the first AF episode. RESULTS One-hundred fifty-three patients were enrolled (69.9% male, 59 ± 10 years, 61.4% paroxysmal AF, 38.6% persistent AF). The time from the first AF episode to the ablation procedure was 1034 ± 1483 days. The ET group comprised 36 patients (25.3%), the DT group 60 (39.2%) and Redo cases were 57 (37.3%). During a mean follow-up of 366 ± 130 days, 18 patients (11.8%) suffered an AF/AT recurrence. More DT patients than ET patients suffered recurrences (15.7% vs. 2.2%, p = 0.0452) and the time to AT/AF recurrence was shorter in the group of patients who received an ablation treatment after 6 months (HR = 6.19, 95% CI: 1.7 to 21.9; p = 0.0474). On multivariate Cox analysis, only hypertension (HR = 4.86, 95% CI: 1.6 to 14.98, p = 0.0062) was independently associated with recurrences. Beyond the hypertension risk factor, ET was associated with a low risk of recurrence; recurrence rate ranged from 0% (ET patients without hypertension) to 25.0% (DT patients with hypertension). CONCLUSIONS An early rhythm-control ablation therapy in the absence of common risk factors was associated with the lowest rate of recurrences.
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Affiliation(s)
| | - Mario Giannotti Santoro
- Second Division of Cardiology, Cardiac, Thoracic, Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giuseppe Stabile
- Clinica Montevergine, Mercogliano, Avellino, Italy.,Anthea Hospital, Bari, Italy
| | | | - Antonio De Simone
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | - Claudio Pandozi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Pietro Rossi
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli, Isola Tiberina, Rome, Italy
| | | | - Domenico Pecora
- Electrophysiology Unit, Cardiovascular Department, Poliambulanza Institute Hospital Foundation, Brescia, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiology, Cardiac, Thoracic, Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardiac, Thoracic, Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | | | - Sara Iuliano
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | - Maurizio Russo
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Maria Lucia Narducci
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Segreti
- Second Division of Cardiology, Cardiac, Thoracic, Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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29
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Weng W, Choudhury R, Sapp J, Tang A, Healey JS, Nault I, Rivard L, Greiss I, Bernick J, Parkash R. The role of brain natriuretic peptide in atrial fibrillation: a substudy of the Substrate Modification with Aggressive Blood Pressure Control for Atrial Fibrillation (SMAC-AF) trial. BMC Cardiovasc Disord 2021; 21:445. [PMID: 34530738 PMCID: PMC8447763 DOI: 10.1186/s12872-021-02254-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Catheter ablation is an established therapy for atrial fibrillation but is limited by recurrence; efforts have been made to identify biomarkers that predict recurrence. We investigated the effect of baseline NT-proBNP on AF recurrence following catheter ablation in patients randomized to aggressive (< 120/80 mmHg) or standard blood pressure management (< 140/90 mmHg) in the Substrate Modification with Aggressive Blood Pressure Control trial (SMAC-AF). METHODS The SMAC-AF study included 173 patients resistant or intolerant to at least one class I or III antiarrhythmic drug. We studied the effect of baseline NT-proBNP on the primary outcome of AF recurrence > 3 months post-ablation. RESULTS Of the 173 patients, 88 were randomized to the aggressive cohort, and 85 into the standard group. The primary outcome occurred in 61.4% of those in the aggressive arm, versus 61.2% in the standard arm. In the aggressive group, logNT-proBNP predicted recurrence (HR 1.28, p = 0.04, adjusted HR 1.43, p = 0.03), while in the standard cohort, it did not (HR 0.94, p = 0.62, adjusted HR 0.83, p = 0.22). NT-proBNP ≥ 280 pg/mL also predicted occurrence in the aggressive (HR 1.98, p = 0.02) but not the standard cohort (HR 1.00, p = 1.00). CONCLUSION We conclude that pre-ablation NT-proBNP may be useful in predicting recurrence in hypertensive patients and identifying patients who benefit from aggressive blood control and upstream therapies. TRIAL REGISTRATION NCT00438113, registered February 21, 2007.
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Affiliation(s)
- Willy Weng
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Rajin Choudhury
- Dalhousie University, 1796 Summer Street, Rm 2501-D, Halifax Infirmary, Halifax, NS, B3H 3A7, Canada
| | - John Sapp
- Dalhousie University, 1796 Summer Street, Rm 2501-D, Halifax Infirmary, Halifax, NS, B3H 3A7, Canada
| | | | | | | | - Lena Rivard
- Montreal Heart Institute, Montreal, QC, Canada
| | - Isabelle Greiss
- Centre Hospitalier de L'Université de Montréal, Montreal, QC, Canada
| | - Jordan Bernick
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ratika Parkash
- Dalhousie University, 1796 Summer Street, Rm 2501-D, Halifax Infirmary, Halifax, NS, B3H 3A7, Canada.
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30
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Chen S, Pürerfellner H, Ouyang F, Kiuchi MG, Meyer C, Martinek M, Futyma P, Zhu L, Schratter A, Wang J, Acou WJ, Ling Z, Yin Y, Liu S, Sommer P, Schmidt B, Chun JKR. Catheter ablation vs. antiarrhythmic drugs as 'first-line' initial therapy for atrial fibrillation: a pooled analysis of randomized data. Europace 2021; 23:1950-1960. [PMID: 34405878 DOI: 10.1093/europace/euab185] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/05/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Catheter ablation (CA) is recommended for patients with atrial fibrillation (AF) after failure of antiarrhythmic drugs (AADs). The role of CA as 'initial therapy' for AF is to be determined. METHODS AND RESULTS Following PRISMA guideline an up-to-date pooled analysis of randomized data comparing ablation vs. AADs as first-line therapy for symptomatic AF was performed. The primary outcome was recurrence of atrial tachyarrhythmia. The secondary outcomes were improvement in quality-of-life (QoL) and major adverse events. A total of 997 patients from five randomized trials were enrolled (mean age 57.4 years, 68.6% male patients, 98% paroxysmal AF, mean follow-up 1.4 years). The baseline characteristics were similar between the ablation and AADs group. Overall pooled analysis showed that, as compared with AADs, CA as first-line therapy was associated with significantly higher freedom from arrhythmia recurrence (69% vs. 48%, odds ratio: 0.36, 95% confidence interval: 0.27-0.48, P < 0.001). This significance was maintained in subgroup analyses of 1- and 2-year follow-up (P < 0.001). Catheter ablation was associated with significantly greater improvement in QoL regarding AFEQT score and 36-Item Short-Form Health Survey score. The incidence of serious adverse events between ablation and AADs group (5.6% vs. 4.9%, P = 0.62) was similar. CONCLUSIONS Catheter ablation as 'initial therapy' was superior to AADs in maintenance of sinus rhythm and improving QoL for patients with symptomatic paroxysmal AF, without increasing risk of serious adverse events.
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Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Wilhelm-Epstein Straße 4, Frankfurt am Main 60431, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Helmut Pürerfellner
- Department für Kardiologie und Elektrophysiologie, Akademisches Lehrkrankenhaus, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Feifan Ouyang
- Klinik und Poliklinik für Kardiologie, Universitäres Herz und Gefäßzentrum, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Márcio Galindo Kiuchi
- School of Medicine-Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Christian Meyer
- Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Cardiology, Evangelical Hospital Düsseldorf, Düsseldorf, Germany.,Heinrich-Heine-University Hospital Düsseldorf, Düsseldorf, Germany
| | - Martin Martinek
- Department für Kardiologie und Elektrophysiologie, Akademisches Lehrkrankenhaus, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Piotr Futyma
- St. Joseph's Heart Rhythm Center, Rzeszów, Poland
| | - Lin Zhu
- Medizinisch-Geriatrische Klinik, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Alexandra Schratter
- Medizinische Abteilung mit Kardiologie, Krankenhaus Hietzing Wien, Vienna, Austria
| | - Jiazhi Wang
- Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Zhiyu Ling
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuehui Yin
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shaowen Liu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Wilhelm-Epstein Straße 4, Frankfurt am Main 60431, Germany
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Wilhelm-Epstein Straße 4, Frankfurt am Main 60431, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
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31
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Mugnai G, de Asmundis C, Sorgente A, Chierchia GB. Cryoballoon ablation as initial treatment for paroxysmal atrial fibrillation: time to change the standard approach? J Cardiovasc Med (Hagerstown) 2021; 22:624-625. [PMID: 34196624 DOI: 10.2459/jcm.0000000000001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Giacomo Mugnai
- Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
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32
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Majumder R, Mohamed Nazer AN, Panfilov AV, Bodenschatz E, Wang Y. Electrophysiological Characterization of Human Atria: The Understated Role of Temperature. Front Physiol 2021; 12:639149. [PMID: 34366877 PMCID: PMC8346027 DOI: 10.3389/fphys.2021.639149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
Ambient temperature has a profound influence on cellular electrophysiology through direct control over the gating mechanisms of different ion channels. In the heart, low temperature is known to favor prolongation of the action potential. However, not much is known about the influence of temperature on other important characterization parameters such as the resting membrane potential (RMP), excitability, morphology and characteristics of the action potential (AP), restitution properties, conduction velocity (CV) of signal propagation, etc. Here we present the first, detailed, systematic in silico study of the electrophysiological characterization of cardiomyocytes from different regions of the normal human atria, based on the effects of ambient temperature (5-50°C). We observe that RMP decreases with increasing temperature. At ~ 48°C, the cells lose their excitability. Our studies show that different parts of the atria react differently to the same changes in temperature. In tissue simulations a drop in temperature correlated positively with a decrease in CV, but the decrease was region-dependent, as expected. In this article we show how this heterogeneous response can provide an explanation for the development of a proarrhythmic substrate during mild hypothermia. We use the above concept to propose a treatment strategy for atrial fibrillation that involves severe hypothermia in specific regions of the heart for a duration of only ~ 200 ms.
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Affiliation(s)
- Rupamanjari Majumder
- Laboratory for Fluid Physics, Pattern Formation and Biocomplexity, Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | | | - Alexander V Panfilov
- World-Class Research Center "Digital Biodesign and Personalized Healthcare", Sechenov University, Moscow, Russia.,Department of Physics and Astronomy, Ghent University, Ghent, Belgium.,Laboratory of Computational Biology and Medicine, Ural Federal University, Yekaterinburg, Russia
| | - Eberhard Bodenschatz
- Laboratory for Fluid Physics, Pattern Formation and Biocomplexity, Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany.,Laboratory of Atomic and Solid-State Physics and Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, United States
| | - Yong Wang
- Laboratory for Fluid Physics, Pattern Formation and Biocomplexity, Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
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33
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Imberti JF, Ding WY, Kotalczyk A, Zhang J, Boriani G, Lip G, Andrade J, Gupta D. Catheter ablation as first-line treatment for paroxysmal atrial fibrillation: a systematic review and meta-analysis. Heart 2021; 107:1630-1636. [PMID: 34261737 DOI: 10.1136/heartjnl-2021-319496] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/08/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To assess the efficacy and safety of catheter ablation (CA) compared with antiarrhythmic drugs (AADs) as first-line treatment for symptomatic paroxysmal atrial fibrillation (AF). METHODS Systematic review and meta-analysis of randomised controlled trials identified using MEDLINE, Cochrane Library and Embase published between 01/01/2000 and 19/03/2021. The primary efficacy endpoint was the first documented recurrence of atrial arrhythmias following the blanking period. The primary safety endpoint was a composite of all serious adverse events (SAEs). RESULTS From 441 records, 6 studies met the inclusion criteria. 609 patients received CA, while 603 received AAD therapy. 212/609 patients in the CA group had a recurrence of atrial arrhythmias as compared with 318/603 in the AADs group resulting in a 36% relative risk reduction (risk ratio: 0.64, 95% CI 0.51 to 0.80, p<0.01). The risk of all SAEs was not statistically different between CA and AAD (0.87, 0.58 to 1.30, p=0.49); 107/609 SAE in the CA group vs 126/603 in the AAD group. Both recurrence of symptomatic atrial arrhythmias (109/505 vs 186/504) and healthcare utilisation (126/397 vs 185/394) were significantly lower in the CA group (0.53, 0.35 to 0.79 and 0.65, 0.48 to 0.89, respectively). There was a 79% reduction in the crossover rate during follow-up among patients randomised to CA compared with AAD (0.21, 0.13 to 0.32, p<0.01). CONCLUSIONS First-line treatment with CA is superior to AAD therapy in patients with symptomatic paroxysmal AF, as it significantly reduces the recurrence of any atrial arrhythmias and symptomatic atrial arrhythmias, and healthcare resource utilisation with comparable safety profile.
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Affiliation(s)
- Jacopo F Imberti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena, Modena, Italy
| | - Wern Yew Ding
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Agnieszka Kotalczyk
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Juqian Zhang
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Giuseppe Boriani
- Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena, Modena, Italy
| | - Gregory Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Jason Andrade
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
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34
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Szilágyi J, Sághy L. Atrial Remodeling in Atrial Fibrillation. Comorbidities and Markers of Disease Progression Predict Catheter Ablation Outcome. Curr Cardiol Rev 2021; 17:217-229. [PMID: 32693769 PMCID: PMC8226201 DOI: 10.2174/1573403x16666200721153620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 01/19/2023] Open
Abstract
Atrial fibrillation is the most common supraventricular arrhythmia affecting an increasing proportion of the population in which mainstream therapy, i.e. catheter ablation, provides freedom from arrhythmia in only a limited number of patients. Understanding the mechanism is key in order to find more effective therapies and to improve patient selection. In this review, the structural and electrophysiological changes of the atrial musculature that constitute atrial remodeling in atrial fibrillaton and how risk factors and markers of disease progression can predict catheter ablation outcome will be discussed in detail.
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Affiliation(s)
- Judit Szilágyi
- 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - László Sághy
- 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
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35
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Turagam MK, Musikantow D, Whang W, Koruth JS, Miller MA, Langan MN, Sofi A, Choudry S, Dukkipati SR, Reddy VY. Assessment of Catheter Ablation or Antiarrhythmic Drugs for First-line Therapy of Atrial Fibrillation: A Meta-analysis of Randomized Clinical Trials. JAMA Cardiol 2021; 6:697-705. [PMID: 33909022 PMCID: PMC8082432 DOI: 10.1001/jamacardio.2021.0852] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/18/2021] [Indexed: 01/01/2023]
Abstract
Importance Early rhythm control of atrial fibrillation (AF) with either antiarrhythmic drugs (AADs) or catheter ablation has been reported to improve cardiovascular outcomes compared with usual care; however, the optimal therapeutic modality to achieve early rhythm control is unclear. Objective To assess the safety and efficacy of AF ablation as first-line therapy when compared with AADs in patients with paroxysmal AF. Data Sources PubMed/MEDLINE, Scopus, Google Scholar, and various major scientific conference sessions from January 1, 2000, through November 23, 2020. Study Selection Randomized clinical trials (RCTs) published in English that had at least 12 months of follow-up and compared clinical outcomes of ablation vs AADs as first-line therapy in adults with AF. The quality of individual studies was assessed using the Cochrane risk of bias tool. Six RCTs met inclusion criteria, including 1212 patients. Data Extraction and Synthesis Two investigators independently extracted data. Reporting was performed in compliance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. Analysis was performed using a random-effects model with the Mantel-Haenszel method, and results are presented as 95% CIs. Main Outcomes and Measures Main outcomes were safety and efficacy of AF ablation as first-line therapy when compared with AADs. Trials were evaluated as having low risk of selection and attrition biases, high risk of performance bias, and with unclear risk for detection biases due to unblinding and open-label designs. Results A total of 6 RCTs involving 1212 patients with AF were included (609 were randomized to AF ablation and 603 to drug therapy; mean [SD] age, 56 [11] years). Compared with AADs, catheter ablation use was associated with reductions in recurrent atrial arrhythmia (32.3% vs 53%; risk ratio [RR], 0.62; 95% CI, 0.51-0.74; P < .001; I2 = 40%), with a number needed to treat with ablation to prevent 1 arrhythmia of 5. Use of ablation was also associated with reduced symptomatic atrial arrhythmia (11.8% vs 26.4%; RR, 0.44; 95% CI, 0.27-0.72; P = .001; I2 = 54%) and hospitalization (5.6% vs 18.7%; RR, 0.32; 95% CI, 0.19-0.53; P < .001) with no significant difference in serious adverse events between the groups (4.2% vs 2.8%; RR, 1.52; 95% CI, 0.81-2.85; P = .19). Conclusions and Relevance In this meta-analysis of randomized clinical trials including first-line therapy of patients with paroxysmal AF, catheter ablation compared with antiarrhythmic drugs was associated with reductions in recurrence of atrial arrhythmias and hospitalizations, with no difference in major adverse events.
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Affiliation(s)
- Mohit K. Turagam
- Helmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York
| | - Daniel Musikantow
- Helmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York
| | - William Whang
- Helmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York
| | - Jacob S. Koruth
- Helmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York
| | - Marc A. Miller
- Helmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York
| | - Marie-Noelle Langan
- Helmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York
| | - Aamir Sofi
- Helmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York
| | - Subbarao Choudry
- Helmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York
| | - Srinivas R. Dukkipati
- Helmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York
| | - Vivek Y. Reddy
- Helmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, New York
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36
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Takamiya T, Nitta J, Inaba O, Sato A, Inamura Y, Murata K, Ikenouchi T, Kono T, Takahashi Y, Goya M, Sasano T. Impact of diagnosis-to-ablation time on non-pulmonary vein triggers and ablation outcomes in persistent atrial fibrillation. J Cardiovasc Electrophysiol 2021; 32:1251-1258. [PMID: 33713521 DOI: 10.1111/jce.15002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Non-pulmonary vein (PV) triggers are a major cause of atrial tachyarrhythmia (ATA) recurrence after catheter ablation. However, the effect of the diagnosis-to-ablation time (DAT) on non-PV triggers in persistent atrial fibrillation is unknown. METHODS AND RESULTS This observational study evaluated 502 consecutive persistent AF patients who underwent initial ablation. We compared 408 patients whose DAT was <3 years with 94 patients whose DAT was ≥3 years. Following PV and posterior wall isolation, 193 non-PV triggers, including 50 AFs, 30 atrial tachycardias (ATs), and 113 repetitive atrial premature beats, were elicited and ablated in 137 (27%) patients. Specifically, 80 non-PV AF/AT triggers were provoked in 64 (13%) patients, being identified more frequently in the DAT ≥ 3 years group than in the DAT < 3 years group (20% vs. 11%, p = .025) especially with a higher prevalence of coronary sinus/inferior left atrial triggers. During a median follow-up of 770 days, the ATA recurrence-free rate was higher in the DAT < 3 years group than the DAT ≥ 3 years group (79% vs. 53% at 2 years, p < .001). In a multivariate analysis, female sex (odds ratio: 2.70, p = .002) and a longer DAT (odds ratio: 1.13/year, p = .008) were predictors of non-PV AF/AT triggers, and a longer DAT (hazard ratio: 1.12/year, p < .001) and non-PV AT/AF triggers (hazard ratio: 1.79, p = .009) were associated with ATA recurrence. CONCLUSION Early ablation after the first diagnosis of persistent AF may reduce emerging non-PV AF/AT triggers and ATA recurrence.
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Affiliation(s)
- Tomomasa Takamiya
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Junichi Nitta
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | | | - Akira Sato
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Yukihiro Inamura
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Kazuya Murata
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Takashi Ikenouchi
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Toshikazu Kono
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Yoshihide Takahashi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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37
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Firouznia M, Feeny AK, LaBarbera MA, McHale M, Cantlay C, Kalfas N, Schoenhagen P, Saliba W, Tchou P, Barnard J, Chung MK, Madabhushi A. Machine Learning-Derived Fractal Features of Shape and Texture of the Left Atrium and Pulmonary Veins From Cardiac Computed Tomography Scans Are Associated With Risk of Recurrence of Atrial Fibrillation Postablation. Circ Arrhythm Electrophysiol 2021; 14:e009265. [PMID: 33576688 PMCID: PMC8015207 DOI: 10.1161/circep.120.009265] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/08/2021] [Indexed: 01/06/2023]
Abstract
[Figure: see text].
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Affiliation(s)
| | - Albert K. Feeny
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve Univ
| | | | - Meghan McHale
- Dept of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland, OH
- Cardiovascular and Metabolic Sciences, Lerner Research Institute, Diagnostic Radiology, Cleveland Clinic, Cleveland, OH
| | - Catherine Cantlay
- Cardiovascular and Metabolic Sciences, Lerner Research Institute, Diagnostic Radiology, Cleveland Clinic, Cleveland, OH
| | - Natalie Kalfas
- Cardiovascular and Metabolic Sciences, Lerner Research Institute, Diagnostic Radiology, Cleveland Clinic, Cleveland, OH
| | - Paul Schoenhagen
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve Univ
- Dept of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland, OH
- Imaging Institute, Diagnostic Radiology, Cleveland Clinic, Cleveland, OH
| | - Walid Saliba
- Dept of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland, OH
| | - Patrick Tchou
- Dept of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland, OH
| | - John Barnard
- Quantitative Health Sciences, Lerner Research Institute, Diagnostic Radiology, Cleveland Clinic, Cleveland, OH
| | - Mina K Chung
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve Univ
- Dept of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland, OH
- Cardiovascular and Metabolic Sciences, Lerner Research Institute, Diagnostic Radiology, Cleveland Clinic, Cleveland, OH
| | - Anant Madabhushi
- Dept of Biomedical Engineering, Case Western Reserve Univ
- Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH
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38
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Wazni OM, Dandamudi G, Sood N, Hoyt R, Tyler J, Durrani S, Niebauer M, Makati K, Halperin B, Gauri A, Morales G, Shao M, Cerkvenik J, Kaplon RE, Nissen SE. Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation. N Engl J Med 2021; 384:316-324. [PMID: 33197158 DOI: 10.1056/nejmoa2029554] [Citation(s) in RCA: 347] [Impact Index Per Article: 115.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND In patients with symptomatic paroxysmal atrial fibrillation that has not responded to medication, catheter ablation is more effective than antiarrhythmic drug therapy for maintaining sinus rhythm. However, the safety and efficacy of cryoballoon ablation as initial first-line therapy have not been established. METHODS We performed a multicenter trial in which patients 18 to 80 years of age who had paroxysmal atrial fibrillation for which they had not previously received rhythm-control therapy were randomly assigned (1:1) to receive treatment with antiarrhythmic drugs (class I or III agents) or pulmonary vein isolation with a cryoballoon. Arrhythmia monitoring included 12-lead electrocardiography conducted at baseline and at 1, 3, 6, and 12 months; patient-activated telephone monitoring conducted weekly and when symptoms were present during months 3 through 12; and 24-hour ambulatory monitoring conducted at 6 and 12 months. The primary efficacy end point was treatment success (defined as freedom from initial failure of the procedure or atrial arrhythmia recurrence after a 90-day blanking period to allow recovery from the procedure or drug dose adjustment, evaluated in a Kaplan-Meier analysis). The primary safety end point was assessed in the ablation group only and was a composite of several procedure-related and cryoballoon system-related serious adverse events. RESULTS Of the 203 participants who underwent randomization and received treatment, 104 underwent ablation, and 99 initially received drug therapy. In the ablation group, initial success of the procedure was achieved in 97% of patients. The Kaplan-Meier estimate of the percentage of patients with treatment success at 12 months was 74.6% (95% confidence interval [CI], 65.0 to 82.0) in the ablation group and 45.0% (95% CI, 34.6 to 54.7) in the drug-therapy group (P<0.001 by log-rank test). Two primary safety end-point events occurred in the ablation group (Kaplan-Meier estimate of the percentage of patients with an event within 12 months, 1.9%; 95% CI, 0.5 to 7.5). CONCLUSIONS Cryoballoon ablation as initial therapy was superior to drug therapy for the prevention of atrial arrhythmia recurrence in patients with paroxysmal atrial fibrillation. Serious procedure-related adverse events were uncommon. (Supported by Medtronic; STOP AF First ClinicalTrials.gov number, NCT03118518.).
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Affiliation(s)
- Oussama M Wazni
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Gopi Dandamudi
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Nitesh Sood
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Robert Hoyt
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Jaret Tyler
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Sarfraz Durrani
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Mark Niebauer
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Kevin Makati
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Blair Halperin
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Andre Gauri
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Gustavo Morales
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Mingyuan Shao
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Jeffrey Cerkvenik
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Rachelle E Kaplon
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
| | - Steven E Nissen
- From Cleveland Clinic, Cleveland (O.M.W., M.N., M.S., S.E.N.), and Ohio State University Medical Center, Columbus (J.T.); CHI Franciscan, Tacoma, WA (G.D.); Southcoast Health System, Fall River, MA (N.S.); Iowa Heart Center, West Des Moines (R.H.); MedStar Heart and Vascular Institute, Washington, DC (S.D.); BayCare Medical Group, Tampa, FL (K.M.); Providence Saint Vincent, Portland, OR (B.H.); Spectrum Health Heart and Vascular, Grand Rapids, MI (A.G.); Grandview Medical Center, Birmingham, AL (G.M.); and Medtronic, Mounds View, MN (J.C., R.E.K.)
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Mandsager KT, Phelan DM, Diab M, Baranowski B, Saliba WI, Tarakji KG, Jaber WA, Kanj M, Tchou P, Lindsay BD, Wazni OM, Hussein AA. Outcomes of Pulmonary Vein Isolation in Athletes. JACC Clin Electrophysiol 2020; 6:1265-1274. [DOI: 10.1016/j.jacep.2020.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 10/23/2022]
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D'Angelo RN, Khanna R, Yeh RW, Goldstein L, Kalsekar I, Marcello S, Tung P, Zimetbaum PJ. Trends and predictors of early ablation for Atrial Fibrillation in a Nationwide population under age 65: a retrospective observational study. BMC Cardiovasc Disord 2020; 20:161. [PMID: 32252637 PMCID: PMC7137521 DOI: 10.1186/s12872-020-01446-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Catheter ablation (CA) has emerged as an effective treatment for symptomatic atrial fibrillation (AF). However practice patterns and patient factors associated with referral for CA within the first 12 months after diagnosis are poorly characterized. This study examined overall procedural trends and factors predictive of catheter ablation for newly-diagnosed atrial fibrillation in a young, commercially-insured population. METHODS A large nationally-representative sample of patients age 20 to 64 from years 2010 to 2016 was studied using the IBM MarketScan® Commercial Database. Patients were included with a new diagnosis of AF in the inpatient or outpatient setting with continuous enrollment for at least 1 year pre and post index visit. Patients were excluded if they had prior history of AF or had filled an anti-arrhythmic drug (AAD) in the pre-index period. RESULTS Early CA increased from 5.0% in 2010 to 10.5% in 2016. Patients were less likely to undergo CA if they were located in the Northeast (OR: 0.80, CI: 0.73-0.88) or North Central (OR: 0.91, CI: 0.83-0.99) regions (compared with the West), had higher CHA2DS2-VASc scores, or had Charlson Comorbidity Index (CCI) score of 3 or greater (OR: 0.61; CI: 0.51-0.72). CONCLUSIONS CA within 12 months for new-diagnosed AF increased significantly from 2010 to 2016, with most patients still trialed on an AAD prior to CA. Patients are less likely to be referred for early CA if they are located in the Northeast and North Central regions, have more comorbidities, or higher CHA2DS2-VASc scores.
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Affiliation(s)
- Robert N D'Angelo
- Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Boston, MA, 02215, USA
| | - Rahul Khanna
- Medical Device Epidemiology and Real World Data Science, Johnson and Johnson, New Brunswick, NJ, USA
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Boston, MA, 02215, USA
| | - Laura Goldstein
- Franchise Health Economics and Market Access, Johnson and Johnson, New Brunswick, NJ, USA
| | - Iftekhar Kalsekar
- Medical Device Epidemiology and Real World Data Science, Johnson and Johnson, New Brunswick, NJ, USA
| | | | - Patricia Tung
- Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Boston, MA, 02215, USA
| | - Peter J Zimetbaum
- Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Boston, MA, 02215, USA.
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Pranata R, Chintya V, Raharjo SB, Yamin M, Yuniadi Y. Longer diagnosis-to-ablation time is associated with recurrence of atrial fibrillation after catheter ablation-Systematic review and meta-analysis. J Arrhythm 2020; 36:289-294. [PMID: 32256876 PMCID: PMC7132183 DOI: 10.1002/joa3.12294] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/26/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diagnosis-to-ablation time (DTAT) has been postulated to be one of the predictors of atrial fibrillation (AF) recurrence, and it is a "modifiable" risk factor unlike that of many electrocardiographic or echocardiographic parameters. This development may change our consideration for ablation. In this systematic review and meta-analysis, we aim to analyze the latest evidence on the importance of DTAT and whether they predict the AF recurrence after catheter ablation. METHODS We performed a comprehensive search on topics that assess diagnosis-to-ablation time (DTAT) and AF recurrence from inception up until August 2019 through PubMed, EuropePMC, Cochrane Central Database, and http://ClinicalTrials.gov. RESULTS There was a total of 3548 patients from six studies. Longer DTAT was associated with increased risk for AF recurrence in all studies included. Meta-analysis of these studies showed that DTAT had a hazard ratio (HR) of 1.19 [1.02, 1.39], P = .03; I 2: 92% for AF recurrence. Upon sensitivity analysis by removing a study, HR became 1.24 [1.16, 1.32], P < .001; I 2: 29%. Meta-analysis on DTAT time >3 years had HR 1.73 [1.54, 1.93], P < .001; I 2: 45% for the recurrence of AF. Upon subgroup analysis of data that compared >6 years to <1 year, the HR was 1.93 [1.62, 2.29], P < .001; I 2: 0%. CONCLUSION Longer DTAT time is associated with an increased risk of AF recurrence. Hence, determining management at the earliest possible moment to avoid delay is of utmost importance.
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Affiliation(s)
- Raymond Pranata
- Faculty of MedicineUniversitas Pelita HarapanTangerangIndonesia
| | - Veresa Chintya
- Faculty of MedicineUniversitas Kristen Krida WacanaJakartaIndonesia
| | - Sunu B. Raharjo
- Department of Cardiology and Vascular MedicineFaculty of Medicine Universitas IndonesiaNational Cardiovascular Center Harapan KitaJakartaIndonesia
| | - Muhammad Yamin
- Division of CardiologyDepartment of Internal MedicineFaculty of Medicine Universitas IndonesiaCipto Mangunkusumo National General HospitalJakartaIndonesia
| | - Yoga Yuniadi
- Department of Cardiology and Vascular MedicineFaculty of Medicine Universitas IndonesiaNational Cardiovascular Center Harapan KitaJakartaIndonesia
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Chew DS, Black-Maier E, Loring Z, Noseworthy PA, Packer DL, Exner DV, Mark DB, Piccini JP. Diagnosis-to-Ablation Time and Recurrence of Atrial Fibrillation Following Catheter Ablation: A Systematic Review and Meta-Analysis of Observational Studies. Circ Arrhythm Electrophysiol 2020; 13:e008128. [PMID: 32191539 DOI: 10.1161/circep.119.008128] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The optimal timing of catheter ablation for atrial fibrillation (AF) in reference to the time of diagnosis is unknown. We sought to assess the impact of the duration between first diagnosis of AF and ablation, or diagnosis-to-ablation time (DAT), on AF recurrence following catheter ablation. METHODS We conducted a systematic electronic search for observational studies reporting the outcomes associated with catheter ablation for atrial fibrillation stratified by diagnosis-to-ablation time. The primary meta-analysis using a random effects model assessed AF recurrence stratified by DAT ≤1 year versus >1 year. A secondary analysis assessed outcomes stratified by DAT ≤3 years versus >3 years. RESULTS Of the 632 screened studies, 6 studies met inclusion criteria for a total of 4950 participants undergoing AF ablation for symptomatic AF. A shorter DAT ≤1 year was associated with a lower relative risk of AF recurrence compared with DAT >1 year (relative risk, 0.73 [95% CI, 0.65-0.82]; P<0.001). Heterogeneity was moderate (I2=51%). When excluding the one study consisting of only patients with persistent AF, the heterogeneity improved substantially (I2=0%, Cochran's Q P=0.55) with a similar estimate of effect (relative risk, 0.78 [95% CI, 0.71-0.85]; P<0.001). CONCLUSIONS Shorter duration between time of first AF diagnosis and AF ablation is associated with an increased likelihood of ablation procedural success. Additional study is required to confirm these results and to explore implementation of earlier catheter AF ablation and patient outcomes within the current AF care pathway. Visual Overview A visual overview is available for this article.
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Affiliation(s)
- Derek S Chew
- Duke Clinical Research Institute, Duke University, Durham, NC (D.S.C., E.B.-M., Z.L., D.B.M., J.P.P.)
| | - Eric Black-Maier
- Duke Clinical Research Institute, Duke University, Durham, NC (D.S.C., E.B.-M., Z.L., D.B.M., J.P.P.)
| | - Zak Loring
- Duke Clinical Research Institute, Duke University, Durham, NC (D.S.C., E.B.-M., Z.L., D.B.M., J.P.P.)
| | - Peter A Noseworthy
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.A.N., D.L.P.)
| | - Douglas L Packer
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (P.A.N., D.L.P.)
| | - Derek V Exner
- Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (D.V.E.)
| | - Daniel B Mark
- Duke Clinical Research Institute, Duke University, Durham, NC (D.S.C., E.B.-M., Z.L., D.B.M., J.P.P.)
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Duke University, Durham, NC (D.S.C., E.B.-M., Z.L., D.B.M., J.P.P.)
- Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, NC (J.P.P.)
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Hussein AA, Wazni OM. Cryoablation for persistent atrial fibrillation: less may be more… sometimes! Europace 2020; 22:333-334. [PMID: 31898730 DOI: 10.1093/europace/euz351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ayman A Hussein
- Department of Cardiovascular Medicine, Center of Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, J2-2, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Center of Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, J2-2, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Shang L, Shao M, Guo Q, Xiaokereti J, Zhao Y, Lu Y, Zhang L, Tang B, Zhou X. Association of Obesity Measures with Atrial Fibrillation Recurrence After Cryoablation in Patients with Paroxysmal Atrial Fibrillation. Med Sci Monit 2020; 26:e920429. [PMID: 32102988 PMCID: PMC7061586 DOI: 10.12659/msm.920429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/10/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Obesity increases the risk of atrial fibrillation (AF) recurrence after ablation. This study explored the relationship between various obesity indexes and risk of recurrence after cryoablation of paroxysmal AF (PAF). MATERIAL AND METHODS Our prospective study included 100 patients with PAF who underwent first cryoablation. Physical examination and fasting blood lipids levels were measured at baseline. Seven obesity indexes were determined: body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), waist-hip ratio (WHR), cardiometabolic index (CMI), lipid accumulation product (LAP), and body adiposity index (BAI). AF recurrence was confirmed by electrocardiograms and Holter monitor at follow-up visits after the initial 3-month blanking period. Receiver operating characteristic (ROC) curves were drawn to assess the abilities of obesity indicators in predicting AF recurrence. Multivariable Cox regression analysis was used to examine independent predictors of AF recurrence. RESULTS During a mean follow-up of 13.4 months, 31 patients (31.0%) had recurrent AF. Patients with recurrence had higher BMI, WC, WHtR, LAP, and BAI compared with those without recurrence. ROC analysis indicated the potential predictive value of BAI with an AUC of 0.657 (95% confidence interval [CI]: 0.534-0.779), followed by WC, WHtR, LAP, and BMI (all P<0.05). Diagnosis-to-ablation time (HR 1.034, 95% CI: 1.002-1.068), left atrial diameter (HR 1.147, 95% CI: 1.026-1.281), and WC (HR 1.026, 95% CI: 1.000-1.053) were independent predictive factors for AF recurrence after multivariable adjustment. CONCLUSIONS In this study population, WC appears to be a potential indicator for the prediction of recurrence in patients with PAF after cryoablation.
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Affiliation(s)
- Luxiang Shang
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
| | - Mengjiao Shao
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
| | - Qilong Guo
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
| | - Jiasuoer Xiaokereti
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
| | - Yang Zhao
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
| | - Yanmei Lu
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
| | - Ling Zhang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
- Clinical Medical Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
| | - Baopeng Tang
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
| | - Xianhui Zhou
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
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Zhang J, Ren Z, Wang S, Zhang J, Yang H, Zheng Y, Meng W, Zhao D, Xu Y. Efficacy and safety of cryoballoon ablation for Chinese patients over 75 years old: A comparison with a younger cohort. J Cardiovasc Electrophysiol 2019; 30:2734-2742. [PMID: 31588616 DOI: 10.1111/jce.14220] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/23/2019] [Accepted: 10/02/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Cryoballoon ablation (CBA) results in satisfactory outcomes for drug-resistant atrial fibrillation (AF) patients. However, the efficacy and safety of CBA have not yet been tested in the Chinese elderly population. Therefore, this study compared the recurrence of AF and complications of CBA in patients ≥75 years and <75 years. METHODS A total of 677 patients (<75 years, n = 550; ≥ 75 years, n = 127) with paroxysmal (n = 603) or persistent (n = 74) non-valvular drug-resistant AF were included. The efficacy was assessed by the recurrence of AF, and the safety was evaluated by peri- and post-procedural complications. RESULTS The CHA2DS2-VASc (2.6 ± 1.7 vs 4.8 ± 1.6, P < .01) and HAS-BLED (1.8 ± 0.8 vs 2.0 ± 0.8, P = .01) scores were significantly higher in the elderly group. The instant pulmonary vein isolation success rate was comparable (99.11% younger vs 98.98% older, P = .99). After a mean follow-up time of 12.8 ± 9.6 months, the 1-year freedom from AF rate was 80.6% vs 85.8% in the older and younger groups, respectively, while the survival analysis showed a nonsignificant difference in the rate of freedom from AF (log-rank P = .46). Cox regression showed that age was not a predictive factor for AF recurrence and was not dichotomized (hazard ratio [HR] = 0.868, 95% confidence interval [CI] 0.509-1.481; P = .6046) or continuous (HR = 0.990, 95% CI, 0.968-1.012, P = .3642). Similar complications rates were observed, including stroke (1.0% younger vs 0.93% older, P = .95) and major hemorrhagic events (1.2% younger vs 0% elder, P = .25). CONCLUSIONS The efficacy and safety profiles of CBA in patients older than 75 years are comparable with those in younger patients.
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Affiliation(s)
- Jun Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhongyuan Ren
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Songyun Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan University School of Medicine, Wuhan, Hubei Province, China
| | - Jingying Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haotian Yang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yixing Zheng
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Weilun Meng
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dongdong Zhao
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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Affiliation(s)
- Bi Huang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China.
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47
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Kuck KH, Brugada J, Fürnkranz A, Chun KRJ, Metzner A, Ouyang F, Schlüter M, Elvan A, Braegelmann KM, Kueffer FJ, Arentz T, Albenque JP, Kühne M, Sticherling C, Tondo C. Impact of Female Sex on Clinical Outcomes in the FIRE AND ICE Trial of Catheter Ablation for Atrial Fibrillation. Circ Arrhythm Electrophysiol 2019; 11:e006204. [PMID: 29700058 DOI: 10.1161/circep.118.006204] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/06/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data on predictors of long-term clinical outcomes after catheter ablation of atrial fibrillation (AF) are limited. We sought to assess the association of baseline covariates with clinical outcomes in the 750 patients with drug-refractory paroxysmal AF enrolled in FIRE AND ICE. METHODS In a 2-part analysis, univariate and multivariable Cox regression models were first used to identify baseline patient characteristics predictive of catheter ablation efficacy determined by the clinical end points of (1) atrial arrhythmia recurrence (primary efficacy failure), (2) cardiovascular rehospitalization, and (3) repeat ablation. Propensity score stratification methods were then used to account for differences in baseline characteristics between sexes. RESULTS Female sex (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.08-1.73; P=0.010) and prior direct current cardioversion (HR, 1.40; 95% CI, 1.07-1.82; P=0.013) were independently associated with atrial arrhythmia recurrence. Female sex (HR, 1.36; 95% CI, 1.02-1.80; P=0.035) and hypertension (HR, 1.48; 95% CI, 1.09-2.00; P=0.013) independently predicted cardiovascular rehospitalization. A longer history of AF (HR, 1.03; 95% CI, 1.00-1.06; P=0.039) increased the rate of repeat ablation. Women continued to have higher rates of primary efficacy failure and cardiovascular rehospitalization after propensity score adjustment, with adjusted HRs of 1.51 (95% CI, 1.16-2.18; P<0.05) and 1.40 (95% CI, 1.15-2.17; P<0.05), respectively. CONCLUSIONS After catheter ablation of paroxysmal AF, female sex was associated with an almost 40% increase in the risks of primary efficacy failure and cardiovascular rehospitalization. Primary efficacy failure was also adversely impacted by a history of direct current cardioversion, whereas hypertension had a negative impact on cardiovascular rehospitalization. History of AF was the only predictor of repeat ablation. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01490814.
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Affiliation(s)
- Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M., F.O., M.S.).
| | - Josep Brugada
- Hospital Clinic, University of Barcelona, Spain (J.B.)
| | - Alexander Fürnkranz
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (A.F., K.R.J.C.).,Dr Fürnkranz's current affiliation: Department of Cardiology, Pneumology, and Angiology, University Hospital Düsseldorf, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (A.F., K.R.J.C.)
| | - Andreas Metzner
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M., F.O., M.S.)
| | - Feifan Ouyang
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M., F.O., M.S.)
| | - Michael Schlüter
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M., F.O., M.S.)
| | - Arif Elvan
- Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A.E.)
| | | | | | - Thomas Arentz
- Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Bad Krozingen, Germany (T.A.)
| | | | - Michael Kühne
- Abteilung für Kardiologie, Universitätsspital Basel, Switzerland (M.K., C.S.)
| | | | - Claudio Tondo
- Monzino Sport Center Arrhythmia Unit, Centro Cardiologico Monzino, University of Milan, Italy (C.T.)
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48
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Bisbal F, Alarcón F, Ferrero‐De‐Loma‐Osorio A, González‐Ferrer JJ, Alonso‐Martín C, Pachón M, Vallés E, Cabanas‐Grandío P, Sanchez M, Benito E, Sarrias A, Ruiz‐Granell R, Pérez‐Villacastín J, Viñolas X, Arias MA, Martí‐Almor J, García‐Campo E, Fernández‐Lozano I, Villuendas R, Mont L. Diagnosis‐to‐ablation time in atrial fibrillation: A modifiable factor relevant to clinical outcome. J Cardiovasc Electrophysiol 2019; 30:1483-1490. [DOI: 10.1111/jce.14000] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/05/2019] [Accepted: 04/20/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Felipe Bisbal
- Heart Institute (iCor)University Hospital Germans Trias i PujolBadalona Spain
- Instituto de Salud Carlos IIICIBERCVMadrid Spain
| | - Francisco Alarcón
- Atrial Fibrillation Unit (UFA), Hospital ClinicUniversitat de Barcelona, IDIBAPSBarcelona Spain
| | | | - Juan Jose González‐Ferrer
- Instituto de Salud Carlos IIICIBERCVMadrid Spain
- Cardiology DepartmentHospital Clinico San CarlosMadrid Spain
| | | | - Marta Pachón
- Cardiology DepartmentHospital Virgen de la SaludToledo Spain
| | | | | | - Manuel Sanchez
- Cardiology DepartmentHospital Puerta de HierroMajadahonda Spain
| | - Eva Benito
- Atrial Fibrillation Unit (UFA), Hospital ClinicUniversitat de Barcelona, IDIBAPSBarcelona Spain
| | - Axel Sarrias
- Heart Institute (iCor)University Hospital Germans Trias i PujolBadalona Spain
| | | | - Julián Pérez‐Villacastín
- Instituto de Salud Carlos IIICIBERCVMadrid Spain
- Cardiology DepartmentHospital Clinico San CarlosMadrid Spain
| | - Xavier Viñolas
- Cardiology DepartmentHospital de la Santa Creu i Sant PauBarcelona Spain
| | | | | | | | | | - Roger Villuendas
- Heart Institute (iCor)University Hospital Germans Trias i PujolBadalona Spain
| | - Lluís Mont
- Instituto de Salud Carlos IIICIBERCVMadrid Spain
- Atrial Fibrillation Unit (UFA), Hospital ClinicUniversitat de Barcelona, IDIBAPSBarcelona Spain
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49
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Su C, Liu Z, Gao Y, Liu Y, Hu RM, Liu J, Yang X, Li S, Zhang Y, Zuo K, Cao B, Luo J, Li J, Li K, Yin X, Chen M, Yang X. Study on the relationship between telomere length changes and recurrence of atrial fibrillation after radiofrequency catheter ablation. J Cardiovasc Electrophysiol 2019; 30:1117-1124. [PMID: 31042327 DOI: 10.1111/jce.13958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/06/2019] [Accepted: 04/11/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Advanced age is the foremost risk factor for atrial fibrillation (AF). Telomere length is a surrogate for biological aging, but the association between shortened leukocyte telomere length (LTL) and recurrence of AF (RAF) after ablation remains inconclusive. METHODS In this prospective analysis, 282 patients underwent an initial catheter ablation for paroxysmal or persistent AF. The association between RAF and LTL was analyzed by univariate and multivariate Cox regression, as well as time-dependent receiver operating characteristic (ROC) analysis and Kaplan-Meier analysis. RESULTS After a mean follow-up of 14.20 ± 5.04 months, RAF was documented in 78 of the 277 patients who completed the study (28.16%). In Cox proportional hazards models, LTL, age, diagnosis to ablation time (DTAT), N-terminal pronatriuretic peptide, and CHA2DS2-VASc score were significantly associated with RAF. After multivariable adjustment, LTL and DTAT were predicted as independent risk factors for RAF with hazard ratio (HR) of 3.17 (95% confidence interval [CI]: 1.23-8.15, P = 0.017) and 1.43 (95% CI: 1.10-1.86, P = 0.007), respectively. In addition, ROC analysis indicated the potential diagnostic value of LTL with an area under the curve of 0.64 (P < 0.001; sensitivity = 60.3%, specificity = 57.8%), and an optimum cut-off value of 1.040. LTL less than or equal to 1.040 was defined as shortened LTL, while LTL greater than 1.040 nonshortened LTL. Kaplan-Meier analysis showed RAF rate curve was separated significantly between two groups (21.2% vs 35.9%, log-rank test result P = 0.007). Patients with shortened LTL might have a higher risk for RAF with HR = 1.84 (P = 0.008). CONCLUSIONS Shortened LTL is an independent risk factor for AF recurrence. Shortened LTL could be a potential biomarker in predicting RAF after ablation.
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Affiliation(s)
- Changyang Su
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Cardiovascular Department, Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, China
| | - Zheng Liu
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuanfeng Gao
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ye Liu
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Rou-Mu Hu
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jia Liu
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiyan Yang
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shichao Li
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuan Zhang
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kun Zuo
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Boli Cao
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jing Luo
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Cardiovascular Department, Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, China
| | - Jing Li
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kuibao Li
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiandong Yin
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Mulei Chen
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xinchun Yang
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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50
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Early choice for catheter ablation reduced readmission in management of atrial fibrillation: Impact of diagnosis-to-ablation time. Int J Cardiol 2019; 291:69-76. [PMID: 30948218 DOI: 10.1016/j.ijcard.2019.03.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/26/2019] [Accepted: 03/18/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND The impact of delays in the treatment with radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) has not been well evaluated. The aim of this study was to investigate the impact of diagnosis-to-ablation time (DAT) on the long-term clinical outcomes after AF-RFCA. METHODS We enrolled 1206 consecutive patients undergoing first-time RFCA for AF. The study population was divided into 2 groups based on DAT: short (<3 years) (N = 675) and long (>3 years) (N = 531) DAT groups. RESULTS Mean follow-up duration was 5.0 ± 2.5 years. The 5-year event-free rates from recurrent atrial tachyarrhythmias after the first and second RFCAs were significantly higher in short DAT group than in long DAT group (60.2% versus 48.3%, log-rank P < 0.001; 83.2% versus 75.2%, log-rank P = 0.02, respectively), leading to reduced cardiovascular hospitalization in short DAT group. After adjusting baseline differences, short DAT was independently associated with lower arrhythmia recurrence rates after the first and second RFCAs (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.60-0.86 and HR 0.72, 95%CI 0.55-0.95, respectively). There were no significant differences between the 2 groups in the event-free rates from all-cause and cardiovascular deaths, heart failure hospitalization, and ischemic stroke. However, among patients with a history of heart failure or reduced left ventricular function, the event-free rate from heart failure readmission was significantly higher in short DAT group (85.0% versus 61.0%, P = 0.004). CONCLUSIONS In the management of AF, early RFCA was associated with significantly lower arrhythmia recurrence compared with delayed RFCA, leading to reduced cardiovascular hospitalization, especially in heart failure patients.
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